Provider Demographics
NPI:1649582750
Name:HAVILI, EMILIE CASSAN (LCSW)
Entity type:Individual
Prefix:
First Name:EMILIE
Middle Name:CASSAN
Last Name:HAVILI
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 1:6144 W 8050 S
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84081-8204
Mailing Address - Country:US
Mailing Address - Phone:801-953-8073
Mailing Address - Fax:
Practice Address - Street 1:8831 S REDWOOD RD
Practice Address - Street 2:STE. D-4
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-9283
Practice Address - Country:US
Practice Address - Phone:385-419-1217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-06
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7697743-3502104100000X
UT5557311041S0200X
UT7697743-3501104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool