Individual
KWIN LESLIE WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
44 N HIGHWAY 91 STE 1, RICHMOND, UT 84333-1419
(435) 535-5784
Mailing address
825 EAST 1090 SOUTH, PROVO, UT 84606
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
9578164-3902
UT
Other
Enumeration date
08/02/2012
Last updated
10/23/2019
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