Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 12225080-2506 | UT |
NPI | 1205417565 |
---|---|
Provider Name | Jared Aaron Stewart |
First Address | Provo, UT 84604-7726 |
Second Address | Provo, UT 84604-7726 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2021 |
Last Update Date | 19/04/2021 |