Provider Demographics
NPI:1316002413
Name:EMMETT, DAVID WILLIAM (MSW)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:WILLIAM
Last Name:EMMETT
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 W 50 N
Mailing Address - Street 2:SUITE 15
Mailing Address - City:VERNAL
Mailing Address - State:UT
Mailing Address - Zip Code:84078-2006
Mailing Address - Country:US
Mailing Address - Phone:435-790-9055
Mailing Address - Fax:
Practice Address - Street 1:335 W 50 N
Practice Address - Street 2:SUITE 15
Practice Address - City:VERNAL
Practice Address - State:UT
Practice Address - Zip Code:84078-2006
Practice Address - Country:US
Practice Address - Phone:435-790-9055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT128918-3501101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health