Healthcare Provider Details

I. General information

NPI: 1902867856
Provider Name (Legal Business Name): CRAIG ENGLAND LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3564 S 7200 W
MAGNA UT
84044-3507
US

IV. Provider business mailing address

3564 S 7200 W
MAGNA UT
84044-3507
US

V. Phone/Fax

Practice location:
  • Phone: 801-250-2909
  • Fax: 801-252-0444
Mailing address:
  • Phone: 801-250-2909
  • Fax: 801-252-0444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1383223501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: