Provider Demographics
NPI:1619232386
Name:DYE, JORDAN LYMAN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JORDAN
Middle Name:LYMAN
Last Name:DYE
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 1:1112 W 3250 N
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-5000
Mailing Address - Country:US
Mailing Address - Phone:801-901-3692
Mailing Address - Fax:
Practice Address - Street 1:1112 W 3250 N
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-5000
Practice Address - Country:US
Practice Address - Phone:801-901-3692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-09
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11772576-3502104100000X
UT1177257635011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker