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Individual

SHAELA GLADE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MS

Contact information

Practice address
663 W 950 S, BRIGHAM CITY, UT 84302-3021
(435) 734-9449
Mailing address
663 W 950 S, BRIGHAM CITY, UT 84302-3021
(435) 734-9449

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
276750-6004
UT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1366766750
UT
Enumeration date
03/15/2010
Last updated
03/05/2019
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