Provider Demographics
NPI:1437652773
Name:THOMAS, ALEXANDRIA MICKELSEN (LCSW)
Entity Type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:MICKELSEN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ALEXANDRIA
Other - Middle Name:
Other - Last Name:MICKELSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1305 E SHALLOW WATER RD
Mailing Address - Street 2:
Mailing Address - City:EAGLE MOUNTAIN
Mailing Address - State:UT
Mailing Address - Zip Code:84005-6060
Mailing Address - Country:US
Mailing Address - Phone:801-717-6391
Mailing Address - Fax:
Practice Address - Street 1:14241 S REDWOOD RD STE 300
Practice Address - Street 2:
Practice Address - City:BLUFFDALE
Practice Address - State:UT
Practice Address - Zip Code:84065-5223
Practice Address - Country:US
Practice Address - Phone:385-342-2808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-13
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
UT11313193-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program