Individual
IVANA MICIC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
150 E 700 S, PROJECT REALITY, SALT LAKE CITY, UT 84111-3806
(801) 364-8080
Mailing address
166 E COATSVILLE AVE, SALT LAKE CITY, UT 84115-1925
(801) 615-4246
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
9424937-3501
UT
1041C0700X
Clinical Social Worker
—
—
Other
Enumeration date
07/24/2013
Last updated
06/22/2022
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