Provider Demographics
NPI:1083050439
Name:MONDRAGON, STEVEN JOSHUA (LCSW)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:JOSHUA
Last Name:MONDRAGON
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 1:68 W 300 S
Mailing Address - Street 2:A
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:UT
Mailing Address - Zip Code:84647-1737
Mailing Address - Country:US
Mailing Address - Phone:435-851-1757
Mailing Address - Fax:
Practice Address - Street 1:68 W 300 S
Practice Address - Street 2:A
Practice Address - City:MOUNT PLEASANT
Practice Address - State:UT
Practice Address - Zip Code:84647-1737
Practice Address - Country:US
Practice Address - Phone:435-851-1757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-13
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8630262-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical