Healthcare Provider Details

I. General information

NPI: 1497006142
Provider Name (Legal Business Name): DANNIEL WORTHEN CULLUMBER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2012
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5965 S 900 E
SALT LAKE CITY UT
84121-1720
US

IV. Provider business mailing address

5965 S 900 E
SALT LAKE CITY UT
84121-1720
US

V. Phone/Fax

Practice location:
  • Phone: 801-263-7100
  • Fax:
Mailing address:
  • Phone: 801-263-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number353735-3503
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: