MEDICARE: BOBBI FOSBURG PSYCHOTHERAPY, LLC

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1144190133
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOBBI FOSBURG PSYCHOTHERAPY, LLC

Provider Business Mailing Address
First Line	:	5944 MARKET ST APT H
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84098-7979
Country	:	US
Telephone Number	:	435-640-3420
Fax Number	:

Provider Business Practice Location Address
First Line	:	3070 RASMUSSEN RD STE 170
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84098-5519
Country	:	US
Telephone Number	:	435-640-3420
Fax Number	:

Authorized Official
Title or Position	:	LCSW
Name	:	BOBBI ANNE FOSBURG
Credential	:
Telephone Number	:	435-640-3420

Provider Enumeration Date	:	11/06/2025
Last Update Date	:	11/06/2025

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