MEDICARE: MRS. NANCY LEE BICE LPC

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	101YM0800X	Mental Health Counselor	6045659-6004	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	60456596004	OTHER	UT	LPC

General Provider Information

NPI Number	:	1134217250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NANCY LEE BICE LPC

Provider Business Mailing Address
First Line	:	2067 ABBEY VIEW RD
Second Line	:
City	:	WEST JORDAN
State	:	UT
Zip	:	84088-6704
Country	:	US
Telephone Number	:	801-898-4846
Fax Number	:

Provider Business Practice Location Address
First Line	:	132 S STATE ST STE 100
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84111-1506
Country	:	US
Telephone Number	:	801-240-6500
Fax Number	:

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

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	07/08/2007

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