Individual
SUSAN EASTON BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1190 N 900 E, PROVO, UT 84604-3536
(801) 422-7620
(801) 422-0165
Mailing address
1190 N 900 E, PROVO, UT 84604-3536
(801) 422-7620
(801) 422-0165
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
8133414-2504
UT
Other
Enumeration date
05/10/2012
Last updated
05/10/2012
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