Provider Demographics
NPI:1881021301
Name:MARY KAY LEHTO LCSW LLC
Entity Type:Organization
Organization Name:MARY KAY LEHTO LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY KAY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEHTO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-647-0752
Mailing Address - Street 1:684 E VINE ST
Mailing Address - Street 2:#4A
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-5548
Mailing Address - Country:US
Mailing Address - Phone:801-647-0752
Mailing Address - Fax:801-293-7106
Practice Address - Street 1:684 E VINE ST
Practice Address - Street 2:#4A
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5548
Practice Address - Country:US
Practice Address - Phone:801-647-0752
Practice Address - Fax:801-293-7106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-29
Last Update Date:2013-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT134639-3501261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)