Provider Demographics
NPI:1043771264
Name:DAVIS, SARAH BETH (SSW)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:BETH
Last Name:DAVIS
Suffix:
Gender:F
Credentials:SSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 E 800 S STE B
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-3827
Mailing Address - Country:US
Mailing Address - Phone:801-924-9240
Mailing Address - Fax:801-924-9241
Practice Address - Street 1:160 E 800 S STE B
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-3827
Practice Address - Country:US
Practice Address - Phone:801-924-9240
Practice Address - Fax:801-924-9241
Is Sole Proprietor?:No
Enumeration Date:2019-03-29
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9452760-3503101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)