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General NPI Number Information
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NPI Number | 1174098487
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Entity Type | Individual
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Provider Name | KRISTINE JOLLEY LANIER CMHC
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Gender | Female
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Dates
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Enumeration Date | 10/12/2018
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Last Update Date | 07/05/2023
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Provider Practice Location Address
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Address Line | 3280 WEST 3500 SOUTH SUITE E
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City | WEST VALLEY CITY
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State | UT
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Zip | 84119-2668
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Country | US
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Telephone | 801-979-1351
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Fax |
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Provider Business Mailing Address
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Address Line | 150 GOLF COURSE RD SUITE E
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City | LOGAN
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State | UT
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Zip | 84321
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 11552307-6009
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License Number State | UT
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