Provider Demographics
NPI:1679041503
Name:CATMULL, CARLA (LCSW)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:CATMULL
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 1:91 W 4750 N
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-5502
Mailing Address - Country:US
Mailing Address - Phone:385-330-0031
Mailing Address - Fax:
Practice Address - Street 1:91 W 4750 N
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-5502
Practice Address - Country:US
Practice Address - Phone:385-330-0031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-08
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8460615-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical