MEDICARE: BLUE SANDS COUNSELING, 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	48971473501	UT

General Provider Information

NPI Number	:	1184918849
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUE SANDS COUNSELING, LLC

Provider Business Mailing Address
First Line	:	2363 N HILL FIELD RD
Second Line	:	SUITE 5
City	:	LAYTON
State	:	UT
Zip	:	84041-6909
Country	:	US
Telephone Number	:	801-513-6866
Fax Number	:	801-728-4516

Provider Business Practice Location Address
First Line	:	2363 N HILL FIELD RD
Second Line	:	SUITE 5
City	:	LAYTON
State	:	UT
Zip	:	84041-6909
Country	:	US
Telephone Number	:	801-513-6866
Fax Number	:	801-728-4516

Authorized Official
Title or Position	:	THERAPIST
Name	:	REBECCA BURGERT
Credential	:	LCSW
Telephone Number	:	801-513-6866

Provider Enumeration Date	:	05/30/2011
Last Update Date	:	05/30/2011

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