Provider Demographics
NPI:1497385728
Name:ARTEAGA, KAYLEM EPHRAIM (LCSW)
Entity Type:Individual
Prefix:
First Name:KAYLEM
Middle Name:EPHRAIM
Last Name:ARTEAGA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1838 S 180 W
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84058-7476
Mailing Address - Country:US
Mailing Address - Phone:801-602-4849
Mailing Address - Fax:
Practice Address - Street 1:1838 S 180 W
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-7476
Practice Address - Country:US
Practice Address - Phone:801-602-4849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-26
Last Update Date:2020-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9294757-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical