Provider Demographics
NPI:1720564362
Name:HENRIE, SKIP A (LCSW)
Entity Type:Individual
Prefix:MR
First Name:SKIP
Middle Name:A
Last Name:HENRIE
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 1:650 E 4500 S STE 300
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-4502
Mailing Address - Country:US
Mailing Address - Phone:801-261-3500
Mailing Address - Fax:801-261-2111
Practice Address - Street 1:650 E 4500 S STE 300
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-4502
Practice Address - Country:US
Practice Address - Phone:801-261-3500
Practice Address - Fax:801-261-2111
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6752601-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical