Individual
TY BRACKEN ALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
545 W 465 N STE 130, PROVIDENCE, UT 84332-8005
(385) 200-3993
Mailing address
PO BOX 583, PROVIDENCE, UT 84332-0583
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
9560142-3902
UT
Other
Enumeration date
10/13/2018
Last updated
10/29/2018
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