Provider Demographics
NPI:1154527091
Name:JILL SABIN SMART, LCSW
Entity type:Organization
Organization Name:JILL SABIN SMART, LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:SABIN
Authorized Official - Last Name:SMART
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-358-4082
Mailing Address - Street 1:PO BOX 1077
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-7077
Mailing Address - Country:US
Mailing Address - Phone:801-358-4082
Mailing Address - Fax:
Practice Address - Street 1:315 S 100 E
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84606-4649
Practice Address - Country:US
Practice Address - Phone:801-358-4082
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT277530-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty