| Utah Lakes Neuroscience Mental Health Center Pllc | |
|
3549 N University Ave Ste 200 Provo UT 84604-4417 | |
| (385) 265-2484 | |
| (877) 894-5104 |
| Full Name | Utah Lakes Neuroscience Mental Health Center Pllc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 3549 N University Ave Ste 200, Provo, Utah |
| Authorized Official Name and Position | Liliana Roney (OWNER) |
| Authorized Official Contact | 3852652484 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Utah Lakes Neuroscience Mental Health Center Pllc 223 W Cougar Blvd # 704 Provo UT 84604-2546 Ph: (385) 265-2484 | Utah Lakes Neuroscience Mental Health Center Pllc 3549 N University Ave Ste 200 Provo UT 84604-4417 Ph: (385) 265-2484 |
| NPI Number | 1609404813 |
|---|---|
| Provider Enumeration Date | 04/01/2020 |
| Last Update Date | 04/02/2020 |
| Certification Date | 04/02/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609404813 | NPI | - | NPPES |
| 11486773-3501 | Other | UT | LCSW LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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