Individual
MR. BLAKE DENVER ALTOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.S., MFT INTERN
Contact information
Practice address
242 ROSEWOOD CIR, LOGAN, UT 84321-5045
(435) 512-1304
Mailing address
242 ROSEWOOD CIR, LOGAN, UT 84321-5045
(435) 512-1304
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
7195889-3904
UT
253J00000X
Foster Care Agency
Primary
—
—
Other
Enumeration date
04/15/2010
Last updated
04/15/2010
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