Individual
JED BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
INTERN
Contact information
Practice address
1407 N 2000 W STE J, CLINTON, UT 84015-8563
(801) 855-7999
(801) 855-7999
Mailing address
1407 N 2000 W STE J, CLINTON, UT 84015-8563
(801) 855-7999
(801) 855-7999
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
05/02/2018
Last updated
05/02/2018
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