Basic Information
Provider Information
NPI: 1083882559
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MULROY
FirstName: SARAH
MiddleName: REEVE
NamePrefix:  
NameSuffix:  
Credential: B.A. PSYCHOLOGY
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5242 S 4820 W
Address2:  
City: KEARNS
State: UT
PostalCode: 841186422
CountryCode: US
TelephoneNumber: 8019664251
FaxNumber: 8019664289
Practice Location
Address1: 5242 S 4820 W
Address2:  
City: KEARNS
State: UT
PostalCode: 841186422
CountryCode: US
TelephoneNumber: 8019664251
FaxNumber: 8019664289
Other Information
ProviderEnumerationDate: 02/18/2008
LastUpdateDate: 03/29/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X  Y Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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