Provider Demographics
NPI:1831679083
Name:LASATER, GARTH JOHN (CSW)
Entity Type:Individual
Prefix:
First Name:GARTH
Middle Name:JOHN
Last Name:LASATER
Suffix:
Gender:M
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:652 NORTH SHADY LANE
Mailing Address - Street 2:
Mailing Address - City:TOQUERVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84774
Mailing Address - Country:US
Mailing Address - Phone:435-215-0500
Mailing Address - Fax:435-215-0505
Practice Address - Street 1:652 NORTH SHADY LANE
Practice Address - Street 2:
Practice Address - City:TOQUERVILLE
Practice Address - State:UT
Practice Address - Zip Code:84774
Practice Address - Country:US
Practice Address - Phone:438-862-9657
Practice Address - Fax:435-215-0505
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT368194-3502104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty