Individual
BENJAMIN BARRET HASLAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1055 E SR 9, VIRGIN, UT 84779-5025
(435) 619-4170
Mailing address
736 S 180 W, HURRICANE, UT 84737-2317
(435) 619-4170
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
10444176-3902
UT
Other
Enumeration date
10/24/2019
Last updated
10/24/2019
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