Provider Demographics
NPI:1235491747
Name:ALBERTSON, REX JERRY (LPC)
Entity Type:Individual
Prefix:
First Name:REX
Middle Name:JERRY
Last Name:ALBERTSON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 S 1300 W
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-3580
Mailing Address - Country:US
Mailing Address - Phone:801-785-9400
Mailing Address - Fax:
Practice Address - Street 1:145 S 1300 W
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-3580
Practice Address - Country:US
Practice Address - Phone:801-785-9400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5752764-6004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional