Provider Demographics
NPI:1871571638
Name:MINER, MARTHA LARAINE (LPC)
Entity type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:LARAINE
Last Name:MINER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:LARAINE
Other - Middle Name:
Other - Last Name:MINER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:5242 S 4820 W
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84118-6422
Mailing Address - Country:US
Mailing Address - Phone:801-966-4251
Mailing Address - Fax:801-966-4289
Practice Address - Street 1:5242 S 4820 W
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84118-6422
Practice Address - Country:US
Practice Address - Phone:801-966-4251
Practice Address - Fax:801-966-4289
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT279317-6004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional