Individual
BRONSON MICHAEL BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
2500 S STATE ST, SOUTH SALT LAKE, UT 84115-3164
(385) 646-1841
Mailing address
5929 S HUMMEL DR, KEARNS, UT 84118-6031
(801) 822-7930
Taxonomy
Speciality
Code
Description
License number
State
101YS0200X
School Counselor
Primary
—
—
Other
Enumeration date
05/23/2022
Last updated
05/23/2022
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