Most Relevant Information
Provider Data
| NPI Number: | 1003175183 |
| Provider Name: | SUSAN EASTON BLACK |
| Entity Type: | Individual |
| Taxonomy Code: | 101YP2500X |
| Specialty: | Counselor |
| License Number: | 8133414-2504 |
Most Important Dates
| Enumeration Date: | 05/10/2012 |
| Last Updated: | 05/10/2012 |
Provider Practice Location
1190 N 900 E
PROVO
UT
846043536
Practice Location Phone/Fax
| Phone: | 8014227620 |
| Fax: | 8014220165 |
Provider Mailing Location
1190 N 900 E
PROVO
UT
846043536
Provider Mailing Phone/Fax
| Phone: | 8014227620 |
| Fax: | 8014220165 |