Provider Demographics
NPI:1801510045
Name:MAAG, AMELIA
Entity type:Individual
Prefix:MISS
First Name:AMELIA
Middle Name:
Last Name:MAAG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMELIA
Other - Middle Name:RAE
Other - Last Name:MAAG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8104 S 6540 W
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84081-6021
Mailing Address - Country:US
Mailing Address - Phone:801-702-7579
Mailing Address - Fax:
Practice Address - Street 1:3355 N UNIVERSITY AVE STE 250
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-6640
Practice Address - Country:US
Practice Address - Phone:385-312-9844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-30
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist