Basic Information
| Provider Information | |||||||||
| NPI: | 1154788271 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NOTARIANNI | ||||||||
| FirstName: | CARMELA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7936 W SHEVA CIR | ||||||||
| Address2: | |||||||||
| City: | MAGNA | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840444405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015180042 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2711 S 8500 W | ||||||||
| Address2: | |||||||||
| City: | MAGNA | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840441307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8019904300 | ||||||||
| FaxNumber: | 8019672127 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2016 | ||||||||
| LastUpdateDate: | 02/01/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 218905-6009 | UT | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YA0400X | 218905-6006 | UT | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.