Provider Demographics
NPI:1336453596
Name:LAZERUS, ANN L (LPC)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:L
Last Name:LAZERUS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 S 600 E
Mailing Address - Street 2:SUITE 8-C
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1999
Mailing Address - Country:US
Mailing Address - Phone:801-414-9650
Mailing Address - Fax:801-363-1785
Practice Address - Street 1:150 S 600 E
Practice Address - Street 2:SUITE 8-C
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1999
Practice Address - Country:US
Practice Address - Phone:801-414-9650
Practice Address - Fax:801-363-1785
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-29
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4933435-6004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional