Provider Demographics
NPI:1710102199
Name:SORENSEN, SCOTT REED (LCSW)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:REED
Last Name:SORENSEN
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 1:554 CEDARWOOD TER
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720-3137
Mailing Address - Country:US
Mailing Address - Phone:435-586-1938
Mailing Address - Fax:435-865-8322
Practice Address - Street 1:351 W CENTER ST
Practice Address - Street 2:CENTRUM #225L
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720-2470
Practice Address - Country:US
Practice Address - Phone:435-586-1938
Practice Address - Fax:435-865-8322
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT140550-3501101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health