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General NPI Number Information
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NPI Number | 1750617791
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Entity Type | Individual
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Provider Name | LYNDSEY PROCTOR LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/27/2009
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Last Update Date | 11/07/2017
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Provider Practice Location Address
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Address Line | 12447 S CROSSING DR STE 13
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City | RIVERTON
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State | UT
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Zip | 84096-7020
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Country | US
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Telephone | 801-984-0184
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Fax | 801-984-0186
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Provider Business Mailing Address
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Address Line | 10367 S OTTER TRAIL DR
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City | SOUTH JORDAN
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State | UT
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Zip | 84009-2290
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Country | US
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Telephone | 801-618-7331
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 87-0359719
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 8699899-3501
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License Number State |
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