Individual
NICHOLAS BLAISE MCDONALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1141 E 3900 S STE A170, MILLCREEK, UT 84124-1250
(888) 949-4864
Mailing address
4460 S HIGHLAND DR, SALT LAKE CITY, UT 84124-3543
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
10903648-6009
UT
Other
Enumeration date
10/16/2018
Last updated
10/16/2018
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