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NPI Code Detail

MEDICARE: MARIE RUSHFORTH-NUTTALL LPC

MEDICARE: MARIE RUSHFORTH-NUTTALL 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
1101YP2500XProfessional Counselor336028-6004UT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
13360028-6004OTHERUTSTATE OF UTAH, DEPARTMENT OF COMMERCE

General Provider Information

NPI Number : 1942339122
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIE RUSHFORTH-NUTTALL LPC
Provider Business Mailing Address
First Line : 1537 S MAIN ST
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84115-5315
Country : US
Telephone Number : 801-712-3252
Fax Number :
Provider Business Practice Location Address
First Line : 1537 S MAIN ST
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84115-5315
Country : US
Telephone Number : 801-712-3252
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/05/2007
Last Update Date : 08/18/2008

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Directions to “ MARIE RUSHFORTH-NUTTALL LPC” Practice Location

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