Provider Demographics
NPI:1003272048
Name:DIPRIMA, IWALANI (ACMHC)
Entity Type:Individual
Prefix:
First Name:IWALANI
Middle Name:
Last Name:DIPRIMA
Suffix:
Gender:F
Credentials:ACMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3149 N HWY 89
Mailing Address - Street 2:200
Mailing Address - City:PLEASANT VIEW
Mailing Address - State:UT
Mailing Address - Zip Code:84404-1201
Mailing Address - Country:US
Mailing Address - Phone:801-782-6600
Mailing Address - Fax:801-782-6551
Practice Address - Street 1:3149 N HWY 89
Practice Address - Street 2:200
Practice Address - City:PLEASANT VIEW
Practice Address - State:UT
Practice Address - Zip Code:84404-1201
Practice Address - Country:US
Practice Address - Phone:801-782-6600
Practice Address - Fax:801-782-6551
Is Sole Proprietor?:No
Enumeration Date:2016-01-06
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5499509-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health