Provider Demographics
NPI:1891492823
Name:MAIO, EMILY E
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:E
Last Name:MAIO
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 1:11667 S EUREKA WAY
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-7916
Mailing Address - Country:US
Mailing Address - Phone:720-563-9299
Mailing Address - Fax:
Practice Address - Street 1:5627 W 13100 S UNIT B
Practice Address - Street 2:
Practice Address - City:HERRIMAN
Practice Address - State:UT
Practice Address - Zip Code:84096-6921
Practice Address - Country:US
Practice Address - Phone:801-217-9600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12890348-3502101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health