NPI 1003175183

Susan Easton Black

Practitioner Professional Counselor Provo, UT

Practice location

Address: 1190 N 900 E, Provo, UT 84604-3536
Phone: (801) 422-7620
Fax: (801) 422-0165

Registered specialties

Professional Counselor Primary

Behavioral Health & Social Service Providers Taxonomy 101YP2500X Licence 8133414-2504 (UT)

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Registry record

NPI: 1003175183
Entity type: Individual
Sex (as registered): Female
NPI issued: 10 May 2012
Record last updated: 10 May 2012

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.