Provider Demographics
NPI:1821357989
Name:SORENSEN, ALIX
Entity type:Individual
Prefix:
First Name:ALIX
Middle Name:
Last Name:SORENSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ALIX
Other - Middle Name:
Other - Last Name:SORENSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PRS PROVIDER
Mailing Address - Street 1:PO BOX 461
Mailing Address - Street 2:
Mailing Address - City:EPHRAIM
Mailing Address - State:UT
Mailing Address - Zip Code:84627-0461
Mailing Address - Country:US
Mailing Address - Phone:435-283-5200
Mailing Address - Fax:435-283-5200
Practice Address - Street 1:390 EAST 100 SOUTH
Practice Address - Street 2:
Practice Address - City:EPHRAIM
Practice Address - State:UT
Practice Address - Zip Code:84627-0000
Practice Address - Country:US
Practice Address - Phone:435-283-5200
Practice Address - Fax:435-283-5200
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-10
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT272503815Medicaid