MEDICARE: MRS. ISABELLE BRINER CPCI

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	101YP2500X	Professional Counselor	5498829-6009	UT

General Provider Information

NPI Number	:	1417168378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ISABELLE BRINER CPCI

Provider Business Mailing Address
First Line	:	1765 CORNWALL CT
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84092-5436
Country	:	US
Telephone Number	:	801-572-5816
Fax Number	:	801-572-0255

Provider Business Practice Location Address
First Line	:	24 S 600 E
Second Line	:	SUITE 6
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-1017
Country	:	US
Telephone Number	:	801-599-6396
Fax Number	:

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

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	07/08/2007

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