MEDICARE: CASSANDRA PICKETT

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	8094968-3902	UT

General Provider Information

NPI Number	:	1801292388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSANDRA PICKETT

Provider Business Mailing Address
First Line	:	50 E 750 N
Second Line	:	17
City	:	VERNAL
State	:	UT
Zip	:	84078-3767
Country	:	US
Telephone Number	:	801-450-5419
Fax Number	:

Provider Business Practice Location Address
First Line	:	1293 W HIGHWAY 40
Second Line	:
City	:	VERNAL
State	:	UT
Zip	:	84078-2923
Country	:	US
Telephone Number	:	801-450-5419
Fax Number	:

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

Provider Enumeration Date	:	11/11/2014
Last Update Date	:	11/11/2014

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Directions to “ CASSANDRA PICKETT ” Practice Location

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