JEREMIAH SOUTHWORTH

PROVO, UT
NPI1104223593
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy101YM0800X Counselor, Mental Health
Additional Taxonomies175T00000X Peer Specialist
Enumeration Date2014-12-01
Last Update Date2020-05-07
Business Address
JEREMIAH SOUTHWORTH
750 N FREEDOM BLVD
PROVO, UT 84601-1677
Phone number: 801-373-4760
Mailing Address
JEREMIAH SOUTHWORTH
750 N FREEDOM BLVD
PROVO, UT 84601-1677
Phone number: 801-373-4760
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