Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003219502 |
---|---|
Provider Name | Dan Mayer |
First Address | Provo, UT 84601-1547 |
Second Address | Mount Pleasant, UT 84647-2309 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2014 |
Last Update Date | 29/09/2014 |