Provider Demographics
NPI:1396960480
Name:WILBURN, MARSHA BARKER (LPC)
Entity type:Individual
Prefix:
First Name:MARSHA
Middle Name:BARKER
Last Name:WILBURN
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 1:1525 N MAIN ST
Mailing Address - Street 2:341
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-6166
Mailing Address - Country:US
Mailing Address - Phone:801-296-2309
Mailing Address - Fax:
Practice Address - Street 1:94 E PAGES LN
Practice Address - Street 2:A
Practice Address - City:CENTERVILLE
Practice Address - State:UT
Practice Address - Zip Code:84014-2216
Practice Address - Country:US
Practice Address - Phone:801-294-0578
Practice Address - Fax:801-298-2147
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC-757101YM0800X
UT7693559-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY311368OtherBCBS OF WYOMING
WY106662500Medicaid
WYW307554Medicare PIN