Provider Demographics
NPI:1245436179
Name:SMART, JILL SABIN (LCSW)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:SABIN
Last Name:SMART
Suffix:
Gender:F
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:PO BOX 1077
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-7077
Mailing Address - Country:US
Mailing Address - Phone:801-358-4082
Mailing Address - Fax:
Practice Address - Street 1:265 N MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:SPANISH FORK
Practice Address - State:UT
Practice Address - Zip Code:84660-1765
Practice Address - Country:US
Practice Address - Phone:801-358-4082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT277530-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical