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Behavioral Health & Social Service Providers Counselor Addiction (Substance Use Disorder)

Provider NPI: 1295037331

Provider Information:
Gender: F
Sole Proprietor

Practice Location:
344 E 100 S STE 301 SALT LAKE CITY, UT 84111-1700 US
Tel: 801-322-4257  Fax: --

Business Mailing Address:
Tel: --  Fax: --

NPI Information:
NPI: 1295037331
Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Y101YA0400XBehavioral Health & Social Service Providers
Addiction (Substance Use Disorder)

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 101YA0400X





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