Provider Demographics
NPI:1386110039
Name:LINEBACK, ANJULI MCKELL (LCSW)
Entity type:Individual
Prefix:
First Name:ANJULI
Middle Name:MCKELL
Last Name:LINEBACK
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 1:1417 E 3000 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-3444
Mailing Address - Country:US
Mailing Address - Phone:801-259-7311
Mailing Address - Fax:
Practice Address - Street 1:1104 E ASHTON AVE STE 103
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-2348
Practice Address - Country:US
Practice Address - Phone:801-259-7321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-21
Last Update Date:2018-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10170686-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical