Healthcare Provider Details

I. General information

NPI: 1083913404
Provider Name (Legal Business Name): KAMI NEVES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2011
Last Update Date: 06/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

857 E 200 S
SALT LAKE CITY UT
84102
US

IV. Provider business mailing address

857 E 200 S
SALT LAKE CITY UT
84102-2317
US

V. Phone/Fax

Practice location:
  • Phone: 801-487-3276
  • Fax:
Mailing address:
  • Phone: 801-487-3276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8410878-6004
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: