Provider Demographics
NPI:1790345015
Name:LOTULELEI, KAY C
Entity Type:Individual
Prefix:MRS
First Name:KAY
Middle Name:C
Last Name:LOTULELEI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7712 S 1100 E
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-2952
Mailing Address - Country:US
Mailing Address - Phone:801-979-8698
Mailing Address - Fax:
Practice Address - Street 1:715 E 3900 S STE 109
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-2568
Practice Address - Country:US
Practice Address - Phone:801-979-8698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty