Healthcare Provider Details

I. General information

NPI: 1871957795
Provider Name (Legal Business Name): LILLIE MARIE PUZEY L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LILLIE MARIE MURRAY

II. Dates (important events)

Enumeration Date: 04/06/2016
Last Update Date: 10/14/2022
Certification Date: 10/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 N. KAYS DR. SUITE 101
KAYSVILLE UT
84037
US

IV. Provider business mailing address

2952 S. 1375 W.
SYRACUSE UT
84075-9067
US

V. Phone/Fax

Practice location:
  • Phone: 801-923-8389
  • Fax:
Mailing address:
  • Phone: 801-674-9516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number345305-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: