Provider Demographics
NPI:1174584940
Name:NIMER, JANELLE (PHD, LCSW)
Entity type:Individual
Prefix:DR
First Name:JANELLE
Middle Name:
Last Name:NIMER
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5284 S COMMERCE DR STE C134
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-5360
Mailing Address - Country:US
Mailing Address - Phone:801-266-4643
Mailing Address - Fax:801-266-4775
Practice Address - Street 1:5284 S COMMERCE DR STE C134
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107
Practice Address - Country:US
Practice Address - Phone:801-266-4643
Practice Address - Fax:801-266-4775
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5933210-35011041C0700X
TN52051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
12060912OtherCAQH