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General NPI Number Information
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NPI Number | 1497212450
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Entity Type | Individual
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Provider Name | TAMARA MAE MANLEY LICSW
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Gender | Female
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Dates
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Enumeration Date | 02/26/2019
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Last Update Date | 12/08/2025
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Provider Practice Location Address
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Address Line | 500 FOOTHILL DR
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City | SALT LAKE CITY
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State | UT
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Zip | 84148-0001
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Country | US
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Telephone | 801-582-1565
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Fax |
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Provider Business Mailing Address
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Address Line | 1283 N 500 W
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City | OREM
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State | UT
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Zip | 84057-2929
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Country | US
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Telephone | 801-830-3096
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 61340040
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 7251107-3501
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License Number State | UT
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