Rebecca Coralyn Bacon, APC
Individual provider Active NPI Professional Counselor · Clearfield, UT
NPI 1508133752 · NPPES record last updated Nov 16, 2011
Key facts
- NPI
- 1508133752
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 78488768-6009 (UT)
- Practice address
- 189 S State St
Ste 160
Clearfield, UT 84015-1061 - Phone
- (801) 773-2044
- Fax
- (801) 773-4826
- NPI assigned
- Nov 16, 2011
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 78488768-6009 | UT | MD | Professional Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 78488768-6009 | UT | Yes |
Addresses
Primary practice location
189 S State St
Ste 160
Clearfield, UT 84015-1061
Mailing address
189 S State St
Ste 160
Clearfield, UT 84015-1061
Phone (801) 773-2044
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All providers in Clearfield, UT · Professional Counselor in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 16, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.