MEDICARE: MRS. TERRY BEGAY L.C.S.W

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	1041C0700X	Clinical Social Worker	374498-3501	UT

General Provider Information

NPI Number	:	1245299049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TERRY BEGAY L.C.S.W

Provider Business Mailing Address
First Line	:	2880 W. 4700 S.
Second Line	:	SUITE A
City	:	WEST VALLEY
State	:	UT
Zip	:	84118
Country	:	US
Telephone Number	:	801-964-2465
Fax Number	:	801-964-9075

Provider Business Practice Location Address
First Line	:	2880 W 4700 S
Second Line	:	SUITE A
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84118-2156
Country	:	US
Telephone Number	:	801-964-2465
Fax Number	:	801-964-9075

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

Provider Enumeration Date	:	03/21/2006
Last Update Date	:	07/08/2007

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