Provider Demographics
NPI:1164913976
Name:WITHUS, PATRICIA (CPE)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:
Last Name:WITHUS
Suffix:
Gender:F
Credentials:CPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11762 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-7155
Mailing Address - Country:US
Mailing Address - Phone:801-649-5566
Mailing Address - Fax:801-649-5966
Practice Address - Street 1:11762 S STATE ST
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-7155
Practice Address - Country:US
Practice Address - Phone:801-649-5566
Practice Address - Fax:801-649-5966
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral