Provider Demographics
NPI:1275858789
Name:SALAZAR, JOSEPH T (CPCI)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:T
Last Name:SALAZAR
Suffix:
Gender:M
Credentials:CPCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:958 W 25 N
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84015-9206
Mailing Address - Country:US
Mailing Address - Phone:801-791-7471
Mailing Address - Fax:
Practice Address - Street 1:958 W 25 N
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:UT
Practice Address - Zip Code:84015-9206
Practice Address - Country:US
Practice Address - Phone:801-791-7471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT75248216009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health