Provider Demographics
NPI:1689855389
Name:STEENBLIK, GLEN (LCSW)
Entity Type:Individual
Prefix:
First Name:GLEN
Middle Name:
Last Name:STEENBLIK
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:PO BOX 900245
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84090-0245
Mailing Address - Country:US
Mailing Address - Phone:801-501-8444
Mailing Address - Fax:
Practice Address - Street 1:7321 S STATE ST
Practice Address - Street 2:#AB
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-2055
Practice Address - Country:US
Practice Address - Phone:801-587-3954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-21
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT120620-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical