Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | UT |
NPI | 1164913976 |
---|---|
Provider Name | Ms. Patricia Withus |
First Address | Draper, UT 84020-7155 |
Second Address | Draper, UT 84020-7155 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2018 |
Last Update Date | 29/05/2018 |