Healthcare Provider Details

I. General information

NPI: 1205142148
Provider Name (Legal Business Name): TIA WHITE DSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2010
Last Update Date: 12/14/2022
Certification Date: 12/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 S 550 E
OREM UT
84097-7136
US

IV. Provider business mailing address

1496 S SAGE VIEW CT
SARATOGA SPRINGS UT
84045-6496
US

V. Phone/Fax

Practice location:
  • Phone: 801-717-9162
  • Fax:
Mailing address:
  • Phone: 801-687-5417
  • Fax: 801-375-4241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number95409303501
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: