Healthcare Provider Details

I. General information

NPI: 1891076634
Provider Name (Legal Business Name): ANNA MARIE HORTON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2011
Last Update Date: 02/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11762 S STATE ST STE 360
DRAPER UT
84020-7166
US

IV. Provider business mailing address

11762 S STATE ST STE 360
DRAPER UT
84020-7166
US

V. Phone/Fax

Practice location:
  • Phone: 801-571-6798
  • Fax:
Mailing address:
  • Phone: 801-571-6798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8388731-3501
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: