| Beacon Therapy Of Utah | |
|
5663 S Redwood Road Suite 2, Office 10 Taylorsville UT 84123-5449 | |
| (208) 604-4355 | |
| Not Available |
| Full Name | Beacon Therapy Of Utah |
|---|---|
| Speciality | Social Worker |
| Location | 5663 S Redwood Road, Taylorsville, Utah |
| Authorized Official Name and Position | Bryan Adam Teuscher (OWNER) |
| Authorized Official Contact | 2086044355 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Beacon Therapy Of Utah 3384 E Summerhill Dr Cottonwood Heights UT 84121-5427 Ph: (208) 604-4355 | Beacon Therapy Of Utah 5663 S Redwood Road Suite 2, Office 10 Taylorsville UT 84123-5449 Ph: (208) 604-4355 |
| NPI Number | 1265149637 |
|---|---|
| Provider Enumeration Date | 11/03/2022 |
| Last Update Date | 08/09/2023 |
| Certification Date | 08/09/2023 |
| Medicare PECOS PAC ID | 3577917178 |
|---|---|
| Medicare Enrollment ID | O20231002000673 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265149637 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Bryan Teuscher |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033586938 PECOS PAC ID: 6204280803 Enrollment ID: I20231002000706 |
| Provider Name | Phoebe Tsz Yan Kung |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1568183853 PECOS PAC ID: 6305291865 Enrollment ID: I20231018002808 |
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