MEDICARE: MRS. MARCELLE CATHERIN BOBO

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1477867042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARCELLE CATHERIN BOBO

Provider Business Mailing Address
First Line	:	457 E 1000 S
Second Line	:
City	:	PLEASANT GROVE
State	:	UT
Zip	:	84062-3623
Country	:	US
Telephone Number	:	801-785-3735
Fax Number	:	801-785-6907

Provider Business Practice Location Address
First Line	:	457 E 1000 S
Second Line	:
City	:	PLEASANT GROVE
State	:	UT
Zip	:	84062-3623
Country	:	US
Telephone Number	:	801-785-3735
Fax Number	:	801-785-6907

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

Provider Enumeration Date	:	08/05/2010
Last Update Date	:	08/05/2010

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