Provider Demographics
NPI:1306919949
Name:PRICE, TERRY BRENT (PH D)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:BRENT
Last Name:PRICE
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 911233
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84791-1233
Mailing Address - Country:US
Mailing Address - Phone:435-705-1226
Mailing Address - Fax:435-627-8542
Practice Address - Street 1:1173 S 250 W STE 202B
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-7045
Practice Address - Country:US
Practice Address - Phone:435-705-1226
Practice Address - Fax:435-627-8542
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT111067-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000007115Medicare PIN