Provider Demographics
NPI:1871186940
Name:UTLEY, JOEL SHANNON III
Entity Type:Individual
Prefix:MR
First Name:JOEL
Middle Name:SHANNON
Last Name:UTLEY
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 DREW LN
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:LA
Mailing Address - Zip Code:71055-2901
Mailing Address - Country:US
Mailing Address - Phone:918-207-2730
Mailing Address - Fax:
Practice Address - Street 1:705 DREW LN
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:LA
Practice Address - Zip Code:71055-2901
Practice Address - Country:US
Practice Address - Phone:918-207-2730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health