Healthcare Provider Details

I. General information

NPI: 1750226411
Provider Name (Legal Business Name): OPHELIA ANN HOLIDAY CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 W MEDICAL DR
MONUMENT VALLEY UT
84536-7705
US

IV. Provider business mailing address

30 W MEDICAL DR
MONUMENT VALLEY UT
84536-7705
US

V. Phone/Fax

Practice location:
  • Phone: 435-459-1135
  • Fax:
Mailing address:
  • Phone: 435-459-1135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number14265101-3502
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: