Individual
CAMILLE SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8686 S 1300 E, SANDY, UT 84094-1947
(801) 709-0748
Mailing address
8686 S 1300 E, SANDY, UT 84094-1947
(801) 750-9090
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
79071956004
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
26-4573566
—
UT
Enumeration date
06/12/2017
Last updated
06/11/2019
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