Provider Demographics
NPI:1265748370
Name:SAIBARA-COOK, KALLI CHIYEMI (PHD)
Entity type:Individual
Prefix:DR
First Name:KALLI
Middle Name:CHIYEMI
Last Name:SAIBARA-COOK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11075 S STATE ST STE 28
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-5176
Mailing Address - Country:US
Mailing Address - Phone:801-501-8444
Mailing Address - Fax:
Practice Address - Street 1:11075 S STATE ST STE 28
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-5176
Practice Address - Country:US
Practice Address - Phone:801-501-8444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-26
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT75660066-2504103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling