Healthcare Provider Details

I. General information

NPI: 1487803912
Provider Name (Legal Business Name): STEPHEN G PRITT LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2008
Last Update Date: 01/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

447 N 300 W SUITE 7
KAYSVILLE UT
84037-4203
US

IV. Provider business mailing address

839 E 2200 S
CLEARFIELD UT
84015-6238
US

V. Phone/Fax

Practice location:
  • Phone: 801-991-0628
  • Fax: 801-660-1186
Mailing address:
  • Phone: 801-991-0628
  • Fax: 801-660-1186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: