Healthcare Provider Details

I. General information

NPI: 1801801667
Provider Name (Legal Business Name): JEANNE LAMAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 07/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4996 W 5850 S
HOOPER UT
84315
US

IV. Provider business mailing address

4996 W 5850 S
HOOPER UT
84315
US

V. Phone/Fax

Practice location:
  • Phone: 801-644-9578
  • Fax:
Mailing address:
  • Phone: 801-644-9578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4808579-6004
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: