Basic Information
Provider Information
NPI: 1578732780
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JUNE
FirstName: MARJORIE
MiddleName: B
NamePrefix:  
NameSuffix:  
Credential: LCSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 474 W 200 N
Address2: SUITE 300
City: ST GEORGE
State: UT
PostalCode: 847704505
CountryCode: US
TelephoneNumber: 4356345600
FaxNumber: 4359868700
Practice Location
Address1: 245 E 680 S
Address2:  
City: CEDAR CITY
State: UT
PostalCode: 847203593
CountryCode: US
TelephoneNumber: 4358677654
FaxNumber: 4358677699
Other Information
ProviderEnumerationDate: 02/22/2008
LastUpdateDate: 02/22/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700X113095-3501UTY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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