Provider Demographics
NPI:1235267121
Name:TRICE, JILL ANN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:ANN
Last Name:TRICE
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 1:1755 N 400 E
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-1954
Mailing Address - Country:US
Mailing Address - Phone:435-760-6721
Mailing Address - Fax:435-752-0303
Practice Address - Street 1:1755 N 400 E
Practice Address - Street 2:SUITE 103
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-1954
Practice Address - Country:US
Practice Address - Phone:435-760-6721
Practice Address - Fax:435-752-0303
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT133958-3501101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health