Provider Demographics
NPI:1841762994
Name:SUSAN MIDDLETON PHD LCSW CONSULTING
Entity Type:Organization
Organization Name:SUSAN MIDDLETON PHD LCSW CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:MIDDLETON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LCSW
Authorized Official - Phone:801-473-4989
Mailing Address - Street 1:1059 N 700 E
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-1327
Mailing Address - Country:US
Mailing Address - Phone:801-473-4989
Mailing Address - Fax:
Practice Address - Street 1:1059 N 700 E
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-1327
Practice Address - Country:US
Practice Address - Phone:801-473-4989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-28
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT139789-3501OtherLICENSED CLINICAL SOCIAL WORKER
UT11008402-0162OtherCERTIFICATE OF REGISTRATION LLC - PROFESSIONAL