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General NPI Number Information
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NPI Number | 1609987957
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Entity Type | Individual
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Provider Name | SHELLY EYRE LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 02/15/2017
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Provider Practice Location Address
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Address Line | 3051 W MAPLE LOOP DR SUITE 201
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City | LEHI
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State | UT
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Zip | 84043-5621
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Country | US
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Telephone | 801-824-0722
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Fax | 801-341-8218
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Provider Business Mailing Address
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Address Line | PO BOX 28128
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City | SALT LAKE CITY
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State | UT
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Zip | 84127-0128
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Country | US
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Telephone | 801-824-0722
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Fax | 801-341-8218
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 1393513501
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 139351-3501
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License Number State | UT
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