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>> Counselor >> Behavioral Health & Social Service Providers

Registrant NPI Number: 1568987212

Individual Registrant:
Gender: M
Not Sole Proprietor

Location and contact information for practice:
4460 S HIGHLAND DR STE 230  SALT LAKE CITY, UT 84124-3550 US
Tel: 888-949-4864  Fax: --

Contact information for business:
4460 S HIGHLAND DR STE 230  SALT LAKE CITY, UT 84124-3550 US
Tel: --  Fax: --

Registration Information:
NPI: 1568987212
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y101Y00000XBehavioral Health & Social Service Providers

Legacy codes, insurance codes and state license numbers:



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