Doctor Name: | AMY BLACK |
NPI Number: | 1811354293 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 2360 N 1450 E Moroni, UT - 846460461 |
Business Phone Number: | 4354455520 |
Business Fax Number: | |
Mailing Address: | 21360 North 1450 East, MORONI |
State: | UT |
Postal Code: | 846460461 |
Phone Number: | 4354455200 |
Fax Number: | 4354455201 |
NPI Enumeration Date: | 01/15/2016 |
NPI Last Update Date: | 01/15/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | UT |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |