Provider Demographics
NPI:1235198722
Name:LEHTO, MARY KAY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARY KAY
Middle Name:
Last Name:LEHTO
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 1:684 E VINE ST
Mailing Address - Street 2:#4A
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-5548
Mailing Address - Country:US
Mailing Address - Phone:801-647-0752
Mailing Address - Fax:801-293-7106
Practice Address - Street 1:684 E VINE ST
Practice Address - Street 2:#4A
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5548
Practice Address - Country:US
Practice Address - Phone:801-647-0752
Practice Address - Fax:801-293-7106
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-22
Last Update Date:2013-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT134639-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT03-0481448OtherEIN