Provider Demographics
NPI:1003083866
Name:HAROLDSEN, LOIS (LCSW)
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:
Last Name:HAROLDSEN
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 1:207 S 300 E
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84606-4743
Mailing Address - Country:US
Mailing Address - Phone:801-356-2864
Mailing Address - Fax:
Practice Address - Street 1:207 S 300 E
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84606-4743
Practice Address - Country:US
Practice Address - Phone:801-356-2864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT309185-3501171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator