Provider Demographics
NPI:1568736361
Name:DAWSON, TERI ELIZABETH (LCSW)
Entity Type:Individual
Prefix:
First Name:TERI
Middle Name:ELIZABETH
Last Name:DAWSON
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 1:857 COLUMBIA LN APT 32
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-6439
Mailing Address - Country:US
Mailing Address - Phone:801-602-5373
Mailing Address - Fax:
Practice Address - Street 1:199 N 290 W STE 150
Practice Address - Street 2:
Practice Address - City:LINDON
Practice Address - State:UT
Practice Address - Zip Code:84042-5004
Practice Address - Country:US
Practice Address - Phone:801-851-7118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-27
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7925388-35011041C0700X
WALW604970551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical