Healthcare Provider Details

I. General information

NPI: 1497243935
Provider Name (Legal Business Name): ELIZABETH ADAIR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2018
Last Update Date: 04/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

724 E 2100 S
SALT LAKE CITY UT
84106-1830
US

IV. Provider business mailing address

866 W 1700 S
WOODS CROSS UT
84087-2171
US

V. Phone/Fax

Practice location:
  • Phone: 801-487-7003
  • Fax:
Mailing address:
  • Phone: 801-289-6489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7311820-3502
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7311820-3502
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number7311820-3502
License Number StateUT
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7311820-3502
License Number StateUT
# 5
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number7311820-3502
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: