Provider Demographics
NPI:1336287135
Name:ANDREASEN, DAMON OLAF (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DAMON
Middle Name:OLAF
Last Name:ANDREASEN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:663 W 950 S
Mailing Address - Street 2:
Mailing Address - City:BRIGHAM CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84302-3021
Mailing Address - Country:US
Mailing Address - Phone:435-734-9449
Mailing Address - Fax:435-723-4851
Practice Address - Street 1:525 E 100 S
Practice Address - Street 2:
Practice Address - City:PRICE
Practice Address - State:UT
Practice Address - Zip Code:84501-3102
Practice Address - Country:US
Practice Address - Phone:435-637-7200
Practice Address - Fax:435-967-2377
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT643762335021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical