Provider Demographics
NPI:1679664957
Name:SHOBER, GUADALUPE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:GUADALUPE
Middle Name:
Last Name:SHOBER
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 1:10094 S WASATCH BLVD
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84092-4572
Mailing Address - Country:US
Mailing Address - Phone:801-634-5334
Mailing Address - Fax:
Practice Address - Street 1:1108 W SOUTH JORDAN PKWY STE C
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-5505
Practice Address - Country:US
Practice Address - Phone:801-856-4647
Practice Address - Fax:801-634-5334
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT63333343506101YM0800X
UT6333334-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health