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1912243197
MARK CUNNINGHAM EVANS
PROVO, UT
NPI
1912243197
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2012-12-17
Last Update Date
2012-12-17
Business Address
-- MARK CUNNINGHAM EVANS
1726 BUCKLEY LN
PROVO, UT 84606-5031
Phone number: 801-373-6562
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Mailing Address
-- MARK CUNNINGHAM EVANS
1775 N 800 W
PLEASANT GROVE, UT 84062
Phone number: 801-671-4519
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