Individual
KELBY TALISA PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
862 S MAIN SUITE 4, BRIGHAM CITY, UT 84302
(435) 753-6245
Mailing address
862 S MAIN SUITE 4, BRIGHAM CITY, UT 84302
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
04/29/2015
Last updated
05/14/2015
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