Provider Demographics
NPI:1811167273
Name:KEIL, MARTI ANN (LCSW)
Entity type:Individual
Prefix:
First Name:MARTI
Middle Name:ANN
Last Name:KEIL
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 1:1470 N MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-5995
Mailing Address - Country:US
Mailing Address - Phone:801-298-5008
Mailing Address - Fax:801-547-0440
Practice Address - Street 1:1470 N MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-5995
Practice Address - Country:US
Practice Address - Phone:801-298-5008
Practice Address - Fax:801-547-0440
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-01
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT141675-3501101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health