Individual
MR. DAVID FULTON QUACKENBUSH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CPCI
Contact information
Practice address
1140 36TH STREET TRISTAN INC., STE 202, OGDEN, UT 84403
(801) 392-0004
(801) 392-2618
Mailing address
452 17TH ST, BEHIND 456, OGDEN, UT 84404-5755
(801) 856-8906
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
7519891-6009
UT
Other
Enumeration date
04/15/2010
Last updated
04/15/2010
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