Healthcare Provider Details

I. General information

NPI: 1932541810
Provider Name (Legal Business Name): ZACHERY PAUL SAMSON LCSW 13703383-3501
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2013
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

174 W 700 N APT C
LOGAN UT
84321-3296
US

IV. Provider business mailing address

174 W 700 N APT C
LOGAN UT
84321-3296
US

V. Phone/Fax

Practice location:
  • Phone: 801-657-1241
  • Fax:
Mailing address:
  • Phone: 801-657-1241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13703383-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: