Basic Information
| Provider Information | |||||||||
| NPI: | 1487091096 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOONS | ||||||||
| FirstName: | NOEL | ||||||||
| MiddleName: | E. | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.S., ACMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2363 N HILL FIELD RD | ||||||||
| Address2: | SUITE #5 | ||||||||
| City: | LAYTON | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840416909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015254645 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2363 N HILL FIELD RD | ||||||||
| Address2: | SUITE #5 | ||||||||
| City: | LAYTON | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840416909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015254645 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2013 | ||||||||
| LastUpdateDate: | 10/28/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 8440518-6009 | UT | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 876000308007 | 05 | UT | MEDICAID | 260022408 | 01 | UT | RAILROAD MEDICARE | OTHER |