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NPI Code Detail

MEDICARE: EMILY JANE RUSSELL LAMFT

MEDICARE: EMILY JANE RUSSELL LAMFT
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
1106H00000XMarriage & Family Therapist13017267-3904UT

General Provider Information

NPI Number : 1528780707
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMILY JANE RUSSELL LAMFT
Provider Business Mailing Address
First Line : 481 E 1000 S STE D
Second Line :
City : PLEASANT GROVE
State : UT
Zip : 84062-3716
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 481 E 1000 S STE D
Second Line :
City : PLEASANT GROVE
State : UT
Zip : 84062-3716
Country : US
Telephone Number : 801-899-2559
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/14/2022
Last Update Date : 09/14/2022

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Directions to “ EMILY JANE RUSSELL LAMFT” Practice Location

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