Provider Demographics
NPI:1376856286
Name:PRENTICE, STEVEN REED (LCSW)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:REED
Last Name:PRENTICE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2880 W 4700 S
Mailing Address - Street 2:SUITE B
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84118-2156
Mailing Address - Country:US
Mailing Address - Phone:801-982-1404
Mailing Address - Fax:801-982-1365
Practice Address - Street 1:2880 W 4700 S
Practice Address - Street 2:SUITE B
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84118-2156
Practice Address - Country:US
Practice Address - Phone:801-982-1404
Practice Address - Fax:801-982-1365
Is Sole Proprietor?:No
Enumeration Date:2010-07-20
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical