Provider Demographics
NPI:1114004306
Name:SORENSON, STEVEN R (LCSW)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:R
Last Name:SORENSON
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 1:4075 LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-2942
Mailing Address - Country:US
Mailing Address - Phone:480-234-6401
Mailing Address - Fax:
Practice Address - Street 1:1186 E 4600 S STE 440
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-4868
Practice Address - Country:US
Practice Address - Phone:801-505-6545
Practice Address - Fax:801-452-6768
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPCSW-251101YM0800X
UT11959463-35011041C0700X
WYLCSW-6161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health