| Mr Wade Poulsen, | |
|
145 E 1300 S, Suite 501, Salt Lake City, UT 84115-5482 | |
| (385) 468-3559 | |
| (385) 468-3560 |
| Full Name | Mr Wade Poulsen |
|---|---|
| Gender | Male |
| Speciality | Mental Health Counselor |
| Experience | 15 Years |
| Location | 145 E 1300 S, Salt Lake City, Utah |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427355650 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 7966792-6004 (Utah) | Primary |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Bear River Mental Health Services Inc | 0840102356 | 16 |
| Entity Name | Bear River Mental Health Services Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1285736553 PECOS PAC ID: 0840102356 Enrollment ID: O20031103000725 |
| Mailing Address | Practice Location Address |
|---|---|
| Mr Wade Poulsen, 145 E 1300 S, Suite 501, Salt Lake City, UT 84115-5482 Ph: (385) 468-3559 | Mr Wade Poulsen, 145 E 1300 S, Suite 501, Salt Lake City, UT 84115-5482 Ph: (385) 468-3559 |
Douglas Ray Stafford, LPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 411 Grant St, Salt Lake City, UT 84116 Phone: 801-359-8862 | |
Mr. Siope Lee Kinikini, CHMC Counselor Medicare: Not Enrolled in Medicare Practice Location: 5800 Highland Dr, Salt Lake City, UT 84121 Phone: 801-272-9980 Fax: 801-272-9976 | |
Jesenia Sanchez, Counselor Medicare: Not Enrolled in Medicare Practice Location: 607 E 200 S, Salt Lake City, UT 84102 Phone: 801-363-0203 Fax: 801-359-3455 | |
Steven Alec Jensen, Counselor Medicare: Not Enrolled in Medicare Practice Location: 5965 S 900 E, Salt Lake City, UT 84121 Phone: 801-263-7100 | |
Austin Giove, Counselor Medicare: Not Enrolled in Medicare Practice Location: 5965 S 900 E, Salt Lake City, UT 84121 Phone: 801-263-7100 | |
Clarissa Weiss, Counselor Medicare: Not Enrolled in Medicare Practice Location: 5965 S 900 E, Salt Lake City, UT 84121 Phone: 801-263-7100 | |
Katalina Takuvaka, Counselor Medicare: Not Enrolled in Medicare Practice Location: 4460 S Highland Dr Ste 210, Salt Lake City, UT 84124 Phone: 888-949-4864 |