MEDICARE: MS. CINDY SQUIRE APRN

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	102911-4405	UT

General Provider Information

NPI Number	:	1477759132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CINDY SQUIRE APRN

Provider Business Mailing Address
First Line	:	928 S. MILITARY DRIVE
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-1326
Country	:	US
Telephone Number	:	801-897-3647
Fax Number	:

Provider Business Practice Location Address
First Line	:	2005 E 2700 S
Second Line	:	ROCK MOUNTAIN PSYCHOLOGICAL SERVICES
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84109-1700
Country	:	US
Telephone Number	:	801-746-7190
Fax Number	:

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

Provider Enumeration Date	:	06/21/2007
Last Update Date	:	07/08/2007

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