Individual
BRYAN RICHARD MOULTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
240 E 300 N, EPHRAIM, UT 84627-1228
(435) 851-6733
Mailing address
240 E 300 N, EPHRAIM, UT 84627-1228
(435) 851-6733
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
6200010-6004
UT
Other
Enumeration date
02/15/2011
Last updated
02/15/2011
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