MEDICARE: DR. BILL CLIFFORD MARSHALL PH.D.

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	112502-3902	UT

General Provider Information

NPI Number	:	1265773899
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BILL CLIFFORD MARSHALL PH.D.

Provider Business Mailing Address
First Line	:	405 S MAPLE DR
Second Line	:
City	:	WOODLAND HILLS
State	:	UT
Zip	:	84653
Country	:	US
Telephone Number	:	801-372-1252
Fax Number	:

Provider Business Practice Location Address
First Line	:	405 S MAPLE DR
Second Line	:
City	:	WOODLAND HILLS
State	:	UT
Zip	:	84653
Country	:	US
Telephone Number	:	801-372-1252
Fax Number	:

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

Provider Enumeration Date	:	03/06/2013
Last Update Date	:	03/06/2013

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