Healthcare Provider Details

I. General information

NPI: 1598377087
Provider Name (Legal Business Name): BETTY CELESTIAL NIUTUPUIVAHA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2020
Last Update Date: 03/15/2023
Certification Date: 03/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 W 200 N
NORTH SALT LAKE UT
84054-2421
US

IV. Provider business mailing address

71 W 200 N
NORTH SALT LAKE UT
84054-2421
US

V. Phone/Fax

Practice location:
  • Phone: 385-243-1660
  • Fax:
Mailing address:
  • Phone: 385-243-1660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11819307-3501
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: