Provider Demographics
NPI:1023212644
Name:ROUTT, TERRY R (LCSW)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:R
Last Name:ROUTT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:756 W 1150 S
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84601-5542
Mailing Address - Country:US
Mailing Address - Phone:801-371-0968
Mailing Address - Fax:
Practice Address - Street 1:570 E 1400 S
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84097-7714
Practice Address - Country:US
Practice Address - Phone:801-426-6661
Practice Address - Fax:801-426-6660
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT134709-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical