Organization
KT&T VENURES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE ROSE PETERS LCMHC (MENTAL HEALTH THERAPY)
(801) 643-2725
Entity
Organization
Contact information
Practice address
1140 36TH ST STE 160, OGDEN, UT 84403-2054
(801) 643-2725
Mailing address
1140 36TH ST STE 160, OGDEN, UT 84403-2054
(801) 643-2725
Taxonomy
Speciality
Code
Description
License number
State
253J00000X
Foster Care Agency
Primary
8616
UT
Other
Enumeration date
12/16/2014
Last updated
12/16/2014
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