Provider Demographics
NPI:1881417111
Name:SLAGLE, ELIZA YVETTE (ACMHC)
Entity type:Individual
Prefix:
First Name:ELIZA
Middle Name:YVETTE
Last Name:SLAGLE
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 1:1960 SIDEWINDER DR STE 103
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84060-7361
Mailing Address - Country:US
Mailing Address - Phone:801-746-4334
Mailing Address - Fax:
Practice Address - Street 1:1960 SIDEWINDER DR STE 103
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84060-7361
Practice Address - Country:US
Practice Address - Phone:801-746-4334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13960906-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health