Provider Demographics
NPI:1437690245
Name:MANSELL, SHAWN (LCSW)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:MANSELL
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 1:12608 S 125 W STE E
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-8437
Mailing Address - Country:US
Mailing Address - Phone:801-810-1119
Mailing Address - Fax:
Practice Address - Street 1:12608 S 125 W STE E
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-8437
Practice Address - Country:US
Practice Address - Phone:801-499-4179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-13
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT899407435011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical