Healthcare Provider Details

I. General information

NPI: 1881528024
Provider Name (Legal Business Name): ELIZA MAAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 E BARROWS AVE
SALT LAKE CITY UT
84106-1626
US

IV. Provider business mailing address

780 E BARROWS AVE
SALT LAKE CITY UT
84106-1626
US

V. Phone/Fax

Practice location:
  • Phone: 802-793-6396
  • Fax:
Mailing address:
  • Phone: 802-793-6396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number13220235-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: