Individual
MR. MANUEL NAZARENO EVANGELISTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
860 EAST 4500 SOUTH #302, SALT LAKE, UT 84107
(801) 268-0333
(801) 268-3777
Mailing address
860 EAST 4500 SOUTH #302, SALT LAKE, UT 84107
(801) 268-0333
(801) 268-3777
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
6417919-3501
UT
Other
Enumeration date
10/07/2009
Last updated
10/07/2009
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