Individual
LYNN KEYTH DURHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
100 S 1000 W, TOOELE, UT 84074-4010
(435) 843-3520
Mailing address
100 S 1000 W, TOOELE, UT 84074-4010
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
00827-I
NV
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
03/24/2011
Last updated
03/21/2013
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