Individual
MRS. CAROL SUE KOFFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1700 PARK AVE, STE 2065, PARK CITY, UT 84060-5160
(435) 659-4508
Mailing address
1700 PARK AVE, STE 2065, PARK CITY, UT 84060-5160
(435) 659-4508
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
65418483501
UT
Other
Enumeration date
05/02/2012
Last updated
05/02/2012
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