Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 62138236004 | UT |
NPI | 1003062811 |
---|---|
Provider Name | Margaret Ann Tan I |
First Address | Park City, UT 84060-7258 |
Second Address | Park City, UT 84060-7258 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2008 |
Last Update Date | 12/08/2008 |