Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | PPC-1179 | WY |
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) |
NPI | 1013034248 |
---|---|
Provider Name | Kaylum James Paletta |
First Address | Salt Lake City, UT 84124-3543 |
Second Address | Salt Lake City, UT 84124-3543 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2007 |
Last Update Date | 29/03/2021 |