Individual
TYSA SLADE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LAMFT
Contact information
Practice address
727 E 1100 S, MAPLETON, UT 84664-5016
(801) 602-8336
Mailing address
727 E 1100 S, MAPLETON, UT 84664-5016
(801) 602-8336
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
106H00000X
Marriage & Family Therapist
Primary
—
—
Other
Enumeration date
03/03/2020
Last updated
11/27/2023
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