Provider Demographics
NPI:1710965447
Name:MITCHELL, SUSAN A (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:A
Last Name:MITCHELL
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 1:3051 W MAPLE LOOP DR
Mailing Address - Street 2:STE 210
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-4602
Mailing Address - Country:US
Mailing Address - Phone:801-263-7231
Mailing Address - Fax:
Practice Address - Street 1:5965 S 900 E STE 240
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-1720
Practice Address - Country:US
Practice Address - Phone:801-263-7231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2662563501101Y00000X, 101YA0400X, 101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT107001386101OtherINTERMTN. HEALTH CARE
UT94293834BOtherCHAMPUS
UT002200233OtherRAILROAD MEDICARE
UT262038OtherDESERET MUTUAL
UT942938348MI2OtherEDUCATORS MUTUAL
UTU000073605Medicare PIN
UTU000073596Medicare PIN
UT262038OtherDESERET MUTUAL
UT94293834BOtherCHAMPUS
UT004662107Medicare PIN
UTU000073597Medicare PIN
UTU000073604Medicare PIN
UTU000073598Medicare PIN