Healthcare Provider Details

I. General information

NPI: 1477561587
Provider Name (Legal Business Name): ROGER KAY LISTER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: KAY LISTER LCSW

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 E 680 S
CEDAR CITY UT
84720-3593
US

IV. Provider business mailing address

474 W 200 N #300
ST GEORGE UT
84770-4505
US

V. Phone/Fax

Practice location:
  • Phone: 435-867-7654
  • Fax: 435-867-7699
Mailing address:
  • Phone: 435-634-5621
  • Fax: 435-986-8700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number132391-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: