Healthcare Provider Details

I. General information

NPI: 1306919949
Provider Name (Legal Business Name): TERRY BRENT PRICE PH. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 06/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1173 S 250 W STE 202B
ST GEORGE UT
84770-7045
US

IV. Provider business mailing address

PO BOX 911233
ST GEORGE UT
84791-1233
US

V. Phone/Fax

Practice location:
  • Phone: 435-705-1226
  • Fax: 435-627-8542
Mailing address:
  • Phone: 435-705-1226
  • Fax: 435-627-8542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number111067-3501
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: