Provider Demographics
NPI:1982120507
Name:MARY EILEEN LEHMAN, LCSW, PLLC
Entity type:Organization
Organization Name:MARY EILEEN LEHMAN, LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:EILEEN
Authorized Official - Last Name:LEHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-201-7661
Mailing Address - Street 1:702 E SOUTH TEMPLE STE B35
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1352
Mailing Address - Country:US
Mailing Address - Phone:801-201-7661
Mailing Address - Fax:
Practice Address - Street 1:702 E SOUTH TEMPLE STE B35
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102
Practice Address - Country:US
Practice Address - Phone:801-201-7661
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-15
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT572584835011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty