Provider Demographics
NPI:1972251288
Name:HARRIS, CARRIE (MS, LCSW)
Entity Type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MS, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1761 E INDIAN WELLS LN
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-8899
Mailing Address - Country:US
Mailing Address - Phone:801-580-6921
Mailing Address - Fax:
Practice Address - Street 1:2332 W 12600 S STE 2C
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-7173
Practice Address - Country:US
Practice Address - Phone:801-209-9797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5172424-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical