Healthcare Provider Details

I. General information

NPI: 1144863374
Provider Name (Legal Business Name): DAVID GUADARRAMA LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2019
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2819 S 5600 W # 114
WEST VALLEY CITY UT
84120-4605
US

IV. Provider business mailing address

6943 S WELL WOOD RD APT 1GG
MIDVALE UT
84047-4029
US

V. Phone/Fax

Practice location:
  • Phone: 435-512-5831
  • Fax:
Mailing address:
  • Phone: 435-512-5831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11835540-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: