MEDICARE: REBECCA ELLEN PRICE LMFT

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	106H00000X	Marriage & Family Therapist	6368023-3902	UT

General Provider Information

NPI Number	:	1083948343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA ELLEN PRICE LMFT

Provider Business Mailing Address
First Line	:	6300 SAGEWOOD DR STE H
Second Line	:	#301
City	:	PARK CITY
State	:	UT
Zip	:	84098-7502
Country	:	US
Telephone Number	:	435-647-6880
Fax Number	:	435-655-0981

Provider Business Practice Location Address
First Line	:	2760 RASMUSSEN RD
Second Line	:	200
City	:	PARK CITY
State	:	UT
Zip	:	84098-5684
Country	:	US
Telephone Number	:	435-729-9089
Fax Number	:	435-655-0981

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

Provider Enumeration Date	:	09/18/2009
Last Update Date	:	09/18/2009

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