Provider Demographics
NPI:1184230518
Name:DEVERAUX, TONI MICHELE (LCSW)
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:MICHELE
Last Name:DEVERAUX
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1326 S 1145 W
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84058-5983
Mailing Address - Country:US
Mailing Address - Phone:801-787-8036
Mailing Address - Fax:
Practice Address - Street 1:4626 N 300 W STE 150
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-6077
Practice Address - Country:US
Practice Address - Phone:801-407-4134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT479121635011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical