Provider Demographics
NPI:1548762990
Name:WINKWORTH, EDWIN III (ACMHC)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:
Last Name:WINKWORTH
Suffix:III
Gender:M
Credentials:ACMHC
Other - Prefix:
Other - First Name:TED
Other - Middle Name:
Other - Last Name:WINKWORTH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:660 S 200 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-3835
Mailing Address - Country:US
Mailing Address - Phone:801-359-8862
Mailing Address - Fax:
Practice Address - Street 1:660 S 200 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-3835
Practice Address - Country:US
Practice Address - Phone:801-359-8862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-01
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health