Provider Demographics
NPI:1336275478
Name:MELLENTHIN, CLAIR (LCSW)
Entity type:Individual
Prefix:MS
First Name:CLAIR
Middle Name:
Last Name:MELLENTHIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1308 S 1700 E STE 210
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-2273
Mailing Address - Country:US
Mailing Address - Phone:801-949-4524
Mailing Address - Fax:801-355-9614
Practice Address - Street 1:1308 S 1700 E STE 210
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-2273
Practice Address - Country:US
Practice Address - Phone:801-949-4524
Practice Address - Fax:801-355-9614
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5228904-3501101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health