Healthcare Provider Details

I. General information

NPI: 1922290436
Provider Name (Legal Business Name): TIMOTHY E ADAMS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2007
Last Update Date: 08/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 EAST 1200 SOUTH
OREM UT
84058-6905
US

IV. Provider business mailing address

251 E 1200 S
OREM UT
84058-6905
US

V. Phone/Fax

Practice location:
  • Phone: 801-226-2255
  • Fax: 801-226-2578
Mailing address:
  • Phone: 801-226-2255
  • Fax: 801-226-2578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number287810-3501
License Number StateUT

VII. Legacy identifiers

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

# 1
Identifier02878103500001
Identifier TypeOTHER
Identifier State
Identifier IssuerBLUE CROSS
# 2
Identifier870298699000
Identifier TypeMEDICAID
Identifier StateUT
Identifier Issuer
# 3
Identifier5995175
Identifier TypeOTHER
Identifier State
Identifier IssuerAETNA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: