Provider Demographics
NPI:1942339122
Name:RUSHFORTH-NUTTALL, MARIE (LPC)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:RUSHFORTH-NUTTALL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1537 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84115-5315
Mailing Address - Country:US
Mailing Address - Phone:801-712-3252
Mailing Address - Fax:
Practice Address - Street 1:1537 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115-5315
Practice Address - Country:US
Practice Address - Phone:801-712-3252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT336028-6004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT3360028-6004OtherSTATE OF UTAH, DEPARTMENT OF COMMERCE