Provider Demographics
NPI:1851561344
Name:WHITWORTH, SHIRLEY (LCSW)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:WHITWORTH
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 1:1965 SUN MEADOW CIR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-3976
Mailing Address - Country:US
Mailing Address - Phone:801-680-8595
Mailing Address - Fax:
Practice Address - Street 1:825 E 4800 S STE 230
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-5516
Practice Address - Country:US
Practice Address - Phone:801-248-3237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-11
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT372976-3501101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health