MEDICARE: STOKES SMITH CSW, LSAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	6817632-6006	UT
2	104100000X	Social Worker	6817632-3502	UT

General Provider Information

NPI Number	:	1316235070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STOKES SMITH CSW, LSAC

Provider Business Mailing Address
First Line	:	2126 E 3300 S BLDG F
Second Line	:	BUILDING F #2126
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84109-2679
Country	:	US
Telephone Number	:	801-870-8399
Fax Number	:

Provider Business Practice Location Address
First Line	:	1390 S 1100 E STE 203
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-2463
Country	:	US
Telephone Number	:	801-983-5700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2011
Last Update Date	:	07/15/2011

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