Individual
BRENDA VAZQUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
545 W 465 N STE 130, PROVIDENCE, UT 84332-8005
(208) 406-7394
(866) 515-9736
Mailing address
545 W 465 N STE 130, PROVIDENCE, UT 84332-8005
(208) 406-7394
(866) 515-9736
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
130095516004
UT
101YM0800X
Mental Health Counselor
Primary
LCPC
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1629250717
PRIVATE INSURERS
ID
Enumeration date
11/29/2007
Last updated
02/15/2024
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