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1184285363
MICHAEL BRENDAN WANLASS
PROVO, UT
NPI
1184285363
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
1041C0700X Social Worker, Clinical
(Licence: UT 7122314-3501)
Enumeration Date
2019-06-27
Last Update Date
2019-06-27
Business Address
MICHAEL BRENDAN WANLASS LCSW
1300 E CENTER ST
PROVO, UT 84606-3554
Phone number: 801-344-4400
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Mailing Address
MICHAEL BRENDAN WANLASS LCSW
PO BOX 270
PROVO, UT 84603-0270
Phone number: 801-344-4400
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