Individual
STACI PAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMFT
Contact information
Practice address
286 W 100 N, EPHRAIM, UT 84627-1132
(435) 851-1079
Mailing address
PO BOX 339, MORONI, UT 84646-0339
(435) 851-1079
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
5410789-3902
UT
Other
Enumeration date
01/14/2022
Last updated
12/04/2024
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