Individual
TAIA SOUTHICHACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ACMHC
Contact information
Practice address
64 S 360 E, AMERICAN FORK, UT 84003-2590
(801) 449-0017
Mailing address
452 N 625 W, CLEARFIELD, UT 84015-3859
(801) 814-8060
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
13498101-6009
UT
Other
Enumeration date
08/11/2023
Last updated
08/11/2023
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