Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 369755-2501 | UT |
NPI | 1053452672 |
---|---|
Provider Name | Dr. Martina Rich |
First Address | Salt Lake City, UT 84105-2315 |
Second Address | Salt Lake City, UT 84132-2119 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2007 |
Last Update Date | 08/07/2007 |