Healthcare Provider Details

I. General information

NPI: 1508753062
Provider Name (Legal Business Name): CASEY J HUMPHREYS CSW, LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2025
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4178 S KIERA HILL LN
SALT LAKE CITY UT
84107-2743
US

IV. Provider business mailing address

4178 S KIERA HILL LN
SALT LAKE CITY UT
84107-2743
US

V. Phone/Fax

Practice location:
  • Phone: 385-377-4411
  • Fax:
Mailing address:
  • Phone: 385-377-4411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number7734967-3502
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7734967-4701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: