MEDICARE: REBECCA M GOOD MA, RNC, ACRN, LPC

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	268995-6004	UT

General Provider Information

NPI Number	:	1801991112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA M GOOD MA, RNC, ACRN, LPC

Provider Business Mailing Address
First Line	:	7730 QUICKSILVER DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-5500
Country	:	US
Telephone Number	:	801-942-5900
Fax Number	:	925-401-1124

Provider Business Practice Location Address
First Line	:	7730 QUICKSILVER DRIVE
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-5500
Country	:	US
Telephone Number	:	801-942-5900
Fax Number	:	925-401-1124

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

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	07/08/2007

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