Provider Demographics
NPI:1518926880
Name:CARTER, MARY ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:CARTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1936 W 140 S
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84059-2663
Mailing Address - Country:US
Mailing Address - Phone:801-318-8634
Mailing Address - Fax:801-377-0930
Practice Address - Street 1:286 S 600 E STE C
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84606-4780
Practice Address - Country:US
Practice Address - Phone:801-318-8634
Practice Address - Fax:801-377-0930
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT590966035021041C0700X
UT5909660-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical