Provider Demographics
NPI:1578107678
Name:CHIPMAN, SETH CONRAD (CSW)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:CONRAD
Last Name:CHIPMAN
Suffix:
Gender:M
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1266 DUNMORE DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-3552
Mailing Address - Country:US
Mailing Address - Phone:801-815-0087
Mailing Address - Fax:
Practice Address - Street 1:763 N 1650 W
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:UT
Practice Address - Zip Code:84663-5066
Practice Address - Country:US
Practice Address - Phone:801-815-0087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-31
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11343983-3502101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor