Individual
PATRICIA GULLBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MFT, RN
Contact information
Practice address
500 FOOTHILL DR, OP116, SALT LAKE CITY, UT 84148-0001
(801) 582-1565
(801) 584-2544
Mailing address
500 FOOTHILL DR, OP116, SALT LAKE CITY, UT 84148-0001
(801) 582-1565
(801) 584-2544
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
19103
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
106H00000X
MARRIAGE FAMILY THERAPIST
CA
Enumeration date
04/01/2010
Last updated
04/01/2010
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