Healthcare Provider Details

I. General information

NPI: 1326277633
Provider Name (Legal Business Name): CHARLES ANDREW HUFF LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2009
Last Update Date: 05/12/2023
Certification Date: 05/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5225 S REDWOOD RD
TAYLORSVILLE UT
84123-4213
US

IV. Provider business mailing address

2500 S STATE ST
SOUTH SALT LAKE UT
84115-3164
US

V. Phone/Fax

Practice location:
  • Phone: 385-646-1406
  • Fax:
Mailing address:
  • Phone: 385-646-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number347047-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: