Individual
MS. AMANDA LIESTA MASELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CADC-I, SUDC
Contact information
Practice address
164 E 5900 S STE 101, MURRAY, UT 84107-7256
(801) 261-5790
(801) 261-5794
Mailing address
164 E 5900 S STE 101, MURRAY, UT 84107-7256
(801) 261-5790
(801) 261-5794
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
11822780-6006
UT
101YA0400X
Addiction (Substance Use Disorder) Counselor
CI10940218
CA
Other
Enumeration date
06/29/2016
Last updated
11/06/2020
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