Provider Demographics
NPI:1295005981
Name:CALLISTER, CATHERINE (LCSW)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:CALLISTER
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 1:140 W 2100 S
Mailing Address - Street 2:SUITE 244
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84115-1852
Mailing Address - Country:US
Mailing Address - Phone:385-231-8387
Mailing Address - Fax:801-660-2474
Practice Address - Street 1:140 W 2100 S
Practice Address - Street 2:SUITE 244
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115-1852
Practice Address - Country:US
Practice Address - Phone:385-231-8387
Practice Address - Fax:801-660-2474
Is Sole Proprietor?:No
Enumeration Date:2012-01-11
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLCSW7741041C0700X
UT9505153-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical