MEDICARE: GARY BARLOW LUNDBERG M.A. - LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	115477-3902	UT

General Provider Information

NPI Number	:	1063628485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY BARLOW LUNDBERG M.A. - LMFT

Provider Business Mailing Address
First Line	:	3680 LITTLE ROCK DR
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84604-5261
Country	:	US
Telephone Number	:	801-224-3447
Fax Number	:	800-122-4345

Provider Business Practice Location Address
First Line	:	3680 LITTLE ROCK DR
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84604-5261
Country	:	US
Telephone Number	:	801-224-3447
Fax Number	:	800-122-4345

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	07/08/2007

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