Healthcare Provider Details

I. General information

NPI: 1184704280
Provider Name (Legal Business Name): ELIZABETH MARIE SEILER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 E 200 N
LOGAN UT
84321-4034
US

IV. Provider business mailing address

PO BOX 507
GARDEN CITY UT
84028-0507
US

V. Phone/Fax

Practice location:
  • Phone: 435-752-0750
  • Fax:
Mailing address:
  • Phone: 435-946-2846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier70576
Identifier TypeOTHER
Identifier StateUT
Identifier IssuerPEHP

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: