Healthcare Provider Details

I. General information

NPI: 1528227451
Provider Name (Legal Business Name): TRENTON D. STARR LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2008
Last Update Date: 08/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S 1000 W
TOOELE UT
84074-4010
US

IV. Provider business mailing address

100 S 1000 W
TOOELE UT
84074-4010
US

V. Phone/Fax

Practice location:
  • Phone: 801-843-3520
  • Fax: 435-843-3555
Mailing address:
  • Phone: 801-843-3520
  • Fax: 435-843-3555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6109715-3501
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: