Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003364001 |
---|---|
Provider Name | Levi Ernest |
First Address | Slc, UT 84124-3543 |
Second Address | Slc, UT 84124-3543 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2016 |
Last Update Date | 19/09/2016 |