Individual
DIANE BINGHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
464 N 300 E, BASEMENT, LOGAN, UT 84321-4117
(208) 650-8362
Mailing address
464 N 300 E, BAMT, LOGAN, UT 84321-4117
(208) 650-8362
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
—
—
253J00000X
Foster Care Agency
Primary
—
—
Other
Enumeration date
09/15/2011
Last updated
09/15/2011
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