Individual
HOLLY PACK SQUIRES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMFT
Contact information
Practice address
1258 W SOUTH JORDAN PKWY, SUITE 202, SOUTH JORDAN, UT 84095-4711
(801) 255-1155
Mailing address
1258 W SOUTH JORDAN PKWY, SUITE 202, SOUTH JORDAN, UT 84095-4711
(801) 255-1155
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
9162614-3902
UT
Other
Enumeration date
10/13/2016
Last updated
10/13/2016
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