Healthcare Provider Details

I. General information

NPI: 1700248341
Provider Name (Legal Business Name): MCCALL HOPKINS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2016
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

571 S 690 E
HYRUM UT
84319-1788
US

IV. Provider business mailing address

571 S 690 E
HYRUM UT
84319-1788
US

V. Phone/Fax

Practice location:
  • Phone: 801-210-1819
  • Fax:
Mailing address:
  • Phone: 801-210-1819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10403366-3501
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 3
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: