MR. Blake Denver Altom, M.S., MFT INTERN

NPI #1255657201 in Logan, Utah

Provider Information

NPI Number: 1255657201
Entity Type: Individual
Name: MR. Blake Denver Altom, M.S., MFT INTERN
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Foster Care Agency
Credential: M.S., MFT INTERN
Enumeration Date: Apr 15, 2010
Last Updated: Apr 15, 2010

Practice Location

Address: 242 ROSEWOOD CIR
City: Logan
State: Utah
ZIP Code: 84321-5045
Phone: (435) 512-1304

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Marriage & Family Therapist	106H00000X
Foster Care Agency	253J00000X	Primary

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