Healthcare Provider Details

I. General information

NPI: 1306979802
Provider Name (Legal Business Name): MARTHA A. KEIL LCSW PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1470 N MAIN ST STE B
BOUNTIFUL UT
84010-5996
US

IV. Provider business mailing address

591 N 125 E
KAYSVILLE UT
84037-1403
US

V. Phone/Fax

Practice location:
  • Phone: 801-298-5008
  • Fax: 801-547-0440
Mailing address:
  • Phone: 801-547-0440
  • Fax: 801-547-0440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number94-141675-3501
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number94-141675-3501
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number94-141675-3501
License Number StateUT

VIII. Authorized Official

Name: MRS. MARTHA A KEIL
Title or Position: PRESIDENT
Credential: LCSW
Phone: 801-298-5008