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NPI Code Detail

MEDICARE: DR. LANCE JUDDSON DOME PHD, LMFT

MEDICARE: DR. LANCE JUDDSON DOME PHD, LMFT
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 Therapist6890279-3902UT

General Provider Information

NPI Number : 1952471898
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LANCE JUDDSON DOME PHD, LMFT
Provider Business Mailing Address
First Line : 24 W SERGEANT COURT DR STE 201
Second Line :
City : SARATOGA SPRINGS
State : UT
Zip : 84045-5809
Country : US
Telephone Number : 801-341-1919
Fax Number :
Provider Business Practice Location Address
First Line : 24 W SERGEANT COURT DR STE 201
Second Line :
City : SARATOGA SPRINGS
State : UT
Zip : 84045-5809
Country : US
Telephone Number : 801-341-1919
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/08/2006
Last Update Date : 02/13/2020

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