Provider Demographics
NPI:1609812940
Name:JEFFRIES, SYDNEY R (LCSW)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:R
Last Name:JEFFRIES
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 1:406 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-6035
Mailing Address - Country:US
Mailing Address - Phone:801-755-2122
Mailing Address - Fax:801-292-0268
Practice Address - Street 1:406 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-6035
Practice Address - Country:US
Practice Address - Phone:801-755-2122
Practice Address - Fax:801-292-0268
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT112679-3501101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT11267935000001OtherBCBS