Provider Demographics
NPI:1740517317
Name:MARELIUS, SALLY
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:MARELIUS
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 1:2915 PATRICIA CIR
Mailing Address - Street 2:
Mailing Address - City:MAGNA
Mailing Address - State:UT
Mailing Address - Zip Code:84044-1375
Mailing Address - Country:US
Mailing Address - Phone:801-651-2828
Mailing Address - Fax:
Practice Address - Street 1:2915 PATRICIA CIR
Practice Address - Street 2:
Practice Address - City:MAGNA
Practice Address - State:UT
Practice Address - Zip Code:84044-1375
Practice Address - Country:US
Practice Address - Phone:801-651-2828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-03
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT355309-6004101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor