Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003359399 |
---|---|
Provider Name | Cheyenne Nicholas |
First Address | Taylorsville, UT 84123-5220 |
Second Address | Taylorsville, UT 84123-5220 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2016 |
Last Update Date | 18/11/2016 |