Healthcare Provider Details

I. General information

NPI: 1124806435
Provider Name (Legal Business Name): AMI JOSEPHINE CURTIS LASUDC, LCSW, MSWI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2023
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 E HIGHWAY 123
SUNNYSIDE UT
84539-7725
US

IV. Provider business mailing address

PO BOX 930
EAST CARBON UT
84520-0930
US

V. Phone/Fax

Practice location:
  • Phone: 435-888-4411
  • Fax:
Mailing address:
  • Phone: 435-888-4411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number10841989-6008
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10841989-3502
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: