Healthcare Provider Details

I. General information

NPI: 1578202883
Provider Name (Legal Business Name): JOSHUA STEVEN SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2022
Last Update Date: 06/03/2022
Certification Date: 06/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 S 100 E STE 300
PAYSON UT
84651-2253
US

IV. Provider business mailing address

95 S 100 E STE 300
PAYSON UT
84651-2253
US

V. Phone/Fax

Practice location:
  • Phone: 801-382-9338
  • Fax: 801-383-0246
Mailing address:
  • Phone: 801-382-9338
  • Fax: 801-383-0246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8752001-3501
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: