Provider Demographics
NPI:1033539770
Name:ALLRED, COURT (CSW)
Entity Type:Individual
Prefix:
First Name:COURT
Middle Name:
Last Name:ALLRED
Suffix:
Gender:M
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 413076
Mailing Address - Street 2:200
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84141-3076
Mailing Address - Country:US
Mailing Address - Phone:801-213-3900
Mailing Address - Fax:801-585-5600
Practice Address - Street 1:650 S KOMAS DR
Practice Address - Street 2:200
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84108-1215
Practice Address - Country:US
Practice Address - Phone:801-581-5515
Practice Address - Fax:801-585-5600
Is Sole Proprietor?:No
Enumeration Date:2014-04-21
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7376215-3502104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker