Healthcare Provider Details

I. General information

NPI: 1043641806
Provider Name (Legal Business Name): JOSEPH ULRICH MSW, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2013
Last Update Date: 09/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6707 S 1300 E
SALT LAKE CITY UT
84121-2718
US

IV. Provider business mailing address

6707 S 1300 E
SALT LAKE CITY UT
84121-2718
US

V. Phone/Fax

Practice location:
  • Phone: 801-662-9308
  • Fax:
Mailing address:
  • Phone: 801-662-9308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: