Provider Demographics
NPI:1699009548
Name:O'REILLY, LA REE COLEEN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LA REE
Middle Name:COLEEN
Last Name:O'REILLY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:L
Other - Middle Name:COLEEN
Other - Last Name:O'REILLY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:415 MEDICAL DR STE D101
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-8905
Mailing Address - Country:US
Mailing Address - Phone:801-683-1062
Mailing Address - Fax:801-295-5537
Practice Address - Street 1:415 MEDICAL DR STE D101
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-8905
Practice Address - Country:US
Practice Address - Phone:801-683-1062
Practice Address - Fax:801-295-5537
Is Sole Proprietor?:No
Enumeration Date:2009-09-24
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7450224-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical