Provider Demographics
NPI:1700020237
Name:MERRITT W STITES LCSW PC
Entity Type:Organization
Organization Name:MERRITT W STITES LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MERRITT
Authorized Official - Middle Name:W
Authorized Official - Last Name:STITES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-359-2240
Mailing Address - Street 1:559 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-3108
Mailing Address - Country:US
Mailing Address - Phone:801-359-2240
Mailing Address - Fax:801-364-1433
Practice Address - Street 1:559 10TH AVE
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84103-3108
Practice Address - Country:US
Practice Address - Phone:801-359-2240
Practice Address - Fax:801-364-1433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-28
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT132817-3501101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000007140Medicare PIN