Individual
GIANNINA FUENTES MENDIETA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
415 MEDICAL DR STE D101, BOUNTIFUL, UT 84010-8905
(801) 683-1062
Mailing address
415 MEDICAL DR STE D101, BOUNTIFUL, UT 84010-8905
(801) 683-1062
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
8483250-3503
UT
Other
Enumeration date
08/22/2016
Last updated
11/27/2023
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