Provider Demographics
NPI:1346943693
Name:ELMI-STUART, LEILA (LCSW)
Entity Type:Individual
Prefix:
First Name:LEILA
Middle Name:
Last Name:ELMI-STUART
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 1:115 GOLF COURSE RD STE A
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-5951
Mailing Address - Country:US
Mailing Address - Phone:435-279-6036
Mailing Address - Fax:435-753-9047
Practice Address - Street 1:93 E 1600 N
Practice Address - Street 2:
Practice Address - City:NORTH LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-3505
Practice Address - Country:US
Practice Address - Phone:435-279-6036
Practice Address - Fax:435-753-9047
Is Sole Proprietor?:No
Enumeration Date:2023-03-24
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9177194-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical