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1619650983
TAIA SOUTHICHACK
AMERICAN FORK, UT
NPI
1619650983
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
101YM0800X Counselor, Mental Health
(Licence: UT 13498101-6009)
Enumeration Date
2023-08-11
Last Update Date
2023-08-11
Business Address
TAIA SOUTHICHACK ACMHC
64 S 360 E
AMERICAN FORK, UT 84003-2590
Phone number: 801-449-0017
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Mailing Address
TAIA SOUTHICHACK ACMHC
452 N 625 W
CLEARFIELD, UT 84015-3859
Phone number: 801-814-8060
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