Doctor Name: | BLAKE TRYTHALL |
NPI Number: | 1366873531 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | |
Business Practice Address: | 2860 East 19500 North Moroni, UT - 846460461 |
Business Phone Number: | 4354455200 |
Business Fax Number: | 4354455201 |
Mailing Address: | 2860 East 19500 North, MORONI |
State: | UT |
Postal Code: | 846460461 |
Phone Number: | 4354455200 |
Fax Number: | 4354455201 |
NPI Enumeration Date: | 12/12/2013 |
NPI Last Update Date: | 12/12/2013 |
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: |