Individual
JUSTIN MANCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CMHC
Contact information
Practice address
415 MEDICAL DR STE D101, BOUNTIFUL, UT 84010-8905
(801) 683-1062
Mailing address
415 MEDICAL DR STE D101, BOUNTIFUL, UT 84010-8905
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
10190973-6004
UT
Other
Enumeration date
03/11/2020
Last updated
10/19/2020
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