Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003238783 |
---|---|
Provider Name | Clarissa Weiss |
First Address | Salt Lake City, UT 84121-1720 |
Second Address | Salt Lake City, UT 84121-1720 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2014 |
Last Update Date | 14/01/2014 |