Provider Demographics
NPI:1114558376
Name:SOTO CEBALLOS, MARTHA LILIA (LCSW, ASUDC)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:LILIA
Last Name:SOTO CEBALLOS
Suffix:
Gender:F
Credentials:LCSW, ASUDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5481 W RIDGE HOLLOW WAY
Mailing Address - Street 2:
Mailing Address - City:KEARNS
Mailing Address - State:UT
Mailing Address - Zip Code:84118-9251
Mailing Address - Country:US
Mailing Address - Phone:385-414-5482
Mailing Address - Fax:
Practice Address - Street 1:4000 S 700 E STE 9
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-2581
Practice Address - Country:US
Practice Address - Phone:801-639-9544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-27
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10378394-35021041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical