Individual
SHANQUETTE PROPHET
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CSW
Contact information
Practice address
5131 S 1500 W, RIVERDALE, UT 84405-3926
(706) 305-5439
Mailing address
232 40TH ST, SOUTH OGDEN, UT 84405-2711
(706) 305-5439
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
13438834-3502
UT
Other
Enumeration date
03/01/2024
Last updated
03/01/2024
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