Individual
KEN C MCCAULEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CMHC
Contact information
Practice address
5454 BALSA AVENUE, WEST JORDAN, UT 84081
(801) 428-9043
Mailing address
5454 BALSA AVENUE, WEST JORDAN, UT 84081
(801) 428-9043
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
357503-6004
UT
Other
Enumeration date
03/14/2014
Last updated
03/14/2014
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