Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003119249 |
---|---|
Provider Name | Shanua Buck |
First Address | Brigham City, UT 84302-0526 |
Second Address | Brigham City, UT 84302-2400 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2010 |
Last Update Date | 16/02/2011 |