Provider Demographics
NPI:1972047306
Name:MCPEAK, SEAN PATRICK (LCSW)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:PATRICK
Last Name:MCPEAK
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 1:150 S 600 E
Mailing Address - Street 2:9B
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1999
Mailing Address - Country:US
Mailing Address - Phone:801-534-0560
Mailing Address - Fax:
Practice Address - Street 1:150 S 600 E
Practice Address - Street 2:9B
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1999
Practice Address - Country:US
Practice Address - Phone:801-534-0560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-04
Last Update Date:2016-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7499914-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical