Healthcare Provider Details

I. General information

NPI: 1235962473
Provider Name (Legal Business Name): DANIEL LELAND POPE CSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2024
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3651 N 100 E STE 300
PROVO UT
84604-4521
US

IV. Provider business mailing address

302 S 740 E UNIT D204
AMERICAN FORK UT
84003-3949
US

V. Phone/Fax

Practice location:
  • Phone: 801-999-8761
  • Fax:
Mailing address:
  • Phone: 385-251-7944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number14288501-3502
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: