Doctor Name: | SHANDI CHILD MICHAEL |
NPI Number: | 1346602133 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 21360 North 1450 East Moroni, UT - 84646 |
Business Phone Number: | 4354455200 |
Business Fax Number: | |
Mailing Address: | Po Box 461, 21360 North 1450 East MORONI |
State: | UT |
Postal Code: | 84646 |
Phone Number: | 4354455200 |
Fax Number: | |
NPI Enumeration Date: | 03/22/2016 |
NPI Last Update Date: | 04/21/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | UT |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |