MEDICARE: MRS. BARBARA ANN MINETTE 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	49587346009	UT

General Provider Information

NPI Number	:	1962487405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BARBARA ANN MINETTE LPC

Provider Business Mailing Address
First Line	:	7187 S 1700 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-3618
Country	:	US
Telephone Number	:	801-270-6523
Fax Number	:

Provider Business Practice Location Address
First Line	:	7187 S 1700 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-3618
Country	:	US
Telephone Number	:	801-270-6523
Fax Number	:

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

Provider Enumeration Date	:	12/07/2005
Last Update Date	:	07/08/2007

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