Provider Demographics
NPI:1316565195
Name:WOODRUFF, DENNIS VIBERT (CMHC)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:VIBERT
Last Name:WOODRUFF
Suffix:
Gender:M
Credentials:CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11576 S STATE ST STE 303
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-7112
Mailing Address - Country:US
Mailing Address - Phone:801-676-9160
Mailing Address - Fax:
Practice Address - Street 1:11576 S STATE ST STE 303
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-7112
Practice Address - Country:US
Practice Address - Phone:801-676-9160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT408093-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health