Individual
AMANDA RAE COSTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S.ED MENTAL HEALTH
Contact information
Practice address
2200 S STATE ST, SALT LAKE CITY, UT 84115-2724
(801) 359-8862
Mailing address
705 E KENSINGTON AVE, SALT LAKE CITY, UT 84105-2224
(786) 553-0488
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
05/31/2018
Last updated
05/31/2018
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