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1487036729
LACEY LARSON
PROVO, UT
NPI
1487036729
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2015-06-23
Last Update Date
2015-06-23
Business Address
-- LACEY LARSON
1726 BUCKLEY LN
PROVO, UT 84606-5031
Phone number: 801-373-6562
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Mailing Address
-- LACEY LARSON
1726 BUCKLEY LN
PROVO, UT 84606-5031
Phone number: 801-373-6562
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