Provider Demographics
NPI:1962702365
Name:BAXTER, RITA STANFORD (CPCI)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:STANFORD
Last Name:BAXTER
Suffix:
Gender:F
Credentials:CPCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1672 W 700 S STE D
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-4963
Mailing Address - Country:US
Mailing Address - Phone:801-489-9721
Mailing Address - Fax:
Practice Address - Street 1:1672 W 700 S STE D
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:UT
Practice Address - Zip Code:84663-4963
Practice Address - Country:US
Practice Address - Phone:801-489-9721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-01
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7623854-6009101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor