Provider Demographics
NPI:1679838965
Name:GOREY, SUSAN HELMA (LCSW, JD)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:HELMA
Last Name:GOREY
Suffix:
Gender:F
Credentials:LCSW, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:461 EAST 500 SOUTH
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-2138
Mailing Address - Country:US
Mailing Address - Phone:801-891-4751
Mailing Address - Fax:866-882-2957
Practice Address - Street 1:461 EAST 500 SOUTH
Practice Address - Street 2:SUITE 100
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-2138
Practice Address - Country:US
Practice Address - Phone:801-891-4751
Practice Address - Fax:866-882-2957
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-12
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7074925-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical