MEDICARE: DENNIS SELLIS CSWI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1700458544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENNIS SELLIS CSWI

Provider Business Mailing Address
First Line	:	352 S DENVER ST STE 315
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84111-3054
Country	:	US
Telephone Number	:	801-520-7938
Fax Number	:

Provider Business Practice Location Address
First Line	:	352 S DENVER ST STE 315
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84111-3054
Country	:	US
Telephone Number	:	801-309-6980
Fax Number	:	800-528-1208

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2021
Last Update Date	:	11/08/2022

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Directions to “ DENNIS SELLIS CSWI” Practice Location

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