Provider Demographics
NPI:1093005308
Name:ELIZABETH DOSHER LCSW
Entity Type:Organization
Organization Name:ELIZABETH DOSHER LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DOSHER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:435-513-2280
Mailing Address - Street 1:2760 W EST RASMUSSEN RD, BLDG D
Mailing Address - Street 2:SUITE 205
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-5177
Mailing Address - Country:US
Mailing Address - Phone:435-513-2280
Mailing Address - Fax:
Practice Address - Street 1:2760 RASMUSSEN RD BLDG D
Practice Address - Street 2:SUITE 205
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098-5684
Practice Address - Country:US
Practice Address - Phone:435-513-2280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-08
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT62245433501261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health