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General NPI Number Information
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NPI Number | 1750170205
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Entity Type | Individual
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Provider Name | LISA MARIE COOLEY
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Gender | Female
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Dates
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Enumeration Date | 05/01/2025
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Last Update Date | 11/04/2025
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Provider Practice Location Address
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Address Line | 13222 TREE SPARROW DR STE R200
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City | RIVERTON
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State | UT
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Zip | 84096-2888
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Country | US
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Telephone | 801-432-0991
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Fax |
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Provider Business Mailing Address
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Address Line | 5024 W FROGS LEAP DR APT 1107
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City | SOUTH JORDAN
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State | UT
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Zip | 84009-4735
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Country | US
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Telephone | 317-440-5167
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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 | 14203295-3502
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License Number State | UT
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