Individual
GLENN SAULALA HAVEA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
720 NORTH 200 WEST, SUITE 300, PROVO, UT 84601
(801) 373-4760
Mailing address
720 NORTH 200 WEST, SUITE 300, PROVO, UT 84601
(801) 373-4760
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2084P0800X(MD,DO)
BEHAVIORA HEALTH & SOCIAL SERVICE PROVIDERS
UT
Enumeration date
04/01/2011
Last updated
04/01/2011
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