Organization
BORAGE WELLNESS CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ABREE SEPULVEDA MIZE LCSW (OWNER, CLINICIAN)
(801) 719-9410
Entity
Organization
Contact information
Practice address
4646 S 3500 W STE 2, WEST HAVEN, UT 84401-9405
(801) 719-9410
Mailing address
4646 S 3500 W STE 2, WEST HAVEN, UT 84401-9405
(801) 719-9410
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
05/15/2023
Last updated
07/03/2024
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