Provider Demographics
NPI:1679052831
Name:BERRETT, LAIL LOUISE (ACMHC)
Entity type:Individual
Prefix:
First Name:LAIL
Middle Name:LOUISE
Last Name:BERRETT
Suffix:
Gender:F
Credentials:ACMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7084 S 2300 E STE 140
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-3969
Mailing Address - Country:US
Mailing Address - Phone:512-788-1132
Mailing Address - Fax:
Practice Address - Street 1:7084 S 2300 E STE 140
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-3969
Practice Address - Country:US
Practice Address - Phone:512-788-1132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-08
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10854940-6004101YM0800X
UT10854940-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health