Provider Demographics
NPI:1184226474
Name:FRANK, MERRILEE BOWCUTT (LBA)
Entity Type:Individual
Prefix:
First Name:MERRILEE
Middle Name:BOWCUTT
Last Name:FRANK
Suffix:
Gender:F
Credentials:LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4957 S PLYMOUTH VIEW DR
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84123-4267
Mailing Address - Country:US
Mailing Address - Phone:801-918-1364
Mailing Address - Fax:
Practice Address - Street 1:4957 S PLYMOUTH VIEW DR
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84123-4267
Practice Address - Country:US
Practice Address - Phone:801-918-1364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT315463-2506103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst