Provider Demographics
NPI:1447039870
Name:BERRY, ELIZABETH NOELLE
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:NOELLE
Last Name:BERRY
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 1:796 E PACIFIC DR STE A
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-3161
Mailing Address - Country:US
Mailing Address - Phone:801-642-2491
Mailing Address - Fax:
Practice Address - Street 1:796 E PACIFIC DR
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-3134
Practice Address - Country:US
Practice Address - Phone:801-642-2984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13409860-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical