Provider Demographics
NPI:1710920301
Name:RICE, DAVID L (MA)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:L
Last Name:RICE
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:483 E 700 N
Mailing Address - Street 2:
Mailing Address - City:VERNAL
Mailing Address - State:UT
Mailing Address - Zip Code:84078-3752
Mailing Address - Country:US
Mailing Address - Phone:208-840-9366
Mailing Address - Fax:208-840-9366
Practice Address - Street 1:483 E 700 N
Practice Address - Street 2:
Practice Address - City:VERNAL
Practice Address - State:UT
Practice Address - Zip Code:84078-3752
Practice Address - Country:US
Practice Address - Phone:208-840-9366
Practice Address - Fax:208-840-9366
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12437858-6004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ931354Medicaid