Provider Demographics
NPI:1225262801
Name:DIEDRICH, LEXI ELANA (CMHC)
Entity type:Individual
Prefix:
First Name:LEXI
Middle Name:ELANA
Last Name:DIEDRICH
Suffix:
Gender:F
Credentials:CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1141 E 3900 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1215
Mailing Address - Country:US
Mailing Address - Phone:801-284-4988
Mailing Address - Fax:
Practice Address - Street 1:4465 S 900 E STE 150
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-3944
Practice Address - Country:US
Practice Address - Phone:435-248-2089
Practice Address - Fax:801-207-5104
Is Sole Proprietor?:No
Enumeration Date:2009-05-11
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT65279556004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional