Provider Demographics
NPI:1487091096
Name:KOONS, NOEL E (MS, ACMHC)
Entity type:Individual
Prefix:MR
First Name:NOEL
Middle Name:E
Last Name:KOONS
Suffix:
Gender:M
Credentials:MS, ACMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2363 N HILL FIELD RD
Mailing Address - Street 2:SUITE #5
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-6909
Mailing Address - Country:US
Mailing Address - Phone:801-525-4645
Mailing Address - Fax:
Practice Address - Street 1:2363 N HILL FIELD RD
Practice Address - Street 2:SUITE #5
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-6909
Practice Address - Country:US
Practice Address - Phone:801-525-4645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-23
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8440518-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT876000308007Medicaid
UT260022408OtherRAILROAD MEDICARE
UT260022408OtherRAILROAD MEDICARE