Provider Demographics
NPI:1942923248
Name:LARA, GAILIA ANN (LMSW)
Entity type:Individual
Prefix:MRS
First Name:GAILIA
Middle Name:ANN
Last Name:LARA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:GAILIA
Other - Middle Name:ANN
Other - Last Name:BEGAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:245 E GORDON LN APT 21
Mailing Address - Street 2:
Mailing Address - City:MILLCREEK
Mailing Address - State:UT
Mailing Address - Zip Code:84107-3102
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5965 S 900 E STE 100
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84121-1850
Practice Address - Country:US
Practice Address - Phone:801-872-5516
Practice Address - Fax:801-212-9942
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-21
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14195871-3502104100000X
IDLSMW-42686104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker