Organization
SEGO LILY CENTER FOR THE ABUSED DEAF
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOENE FARRIS NICOLAISEN LPC (EXECUTIVE DIRECTOR)
(888) 328-5486
Entity
Organization
Contact information
Practice address
6526 S STATE ST, 404, MURRAY, UT 84107-7261
(888) 328-5486
(888) 328-5486
Mailing address
PO BOX 71279, SALT LAKE CITY, UT 84171-0279
(888) 328-5486
(888) 328-5486
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
50526596004
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
251S00000X
—
UT
Enumeration date
07/03/2009
Last updated
07/03/2009
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