Individual
MR. RAFAEL ALEXANDER IBARRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APC
Contact information
Practice address
750 N FREEDOM BLVD STE 300, PROVO, UT 84601-1690
(801) 373-4760
Mailing address
750 N FREEDOM BLVD STE 300, PROVO, UT 84601-1690
(801) 373-4760
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
7894027-6004
UT
101YP2500X
Professional Counselor
7894027-6009
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1356357115
—
UT
Enumeration date
02/14/2011
Last updated
04/26/2023
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