Provider Demographics
NPI:1205142148
Name:WHITE, TIA (DSW, LCSW)
Entity type:Individual
Prefix:DR
First Name:TIA
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:DSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1496 S SAGE VIEW CT
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:UT
Mailing Address - Zip Code:84045-6496
Mailing Address - Country:US
Mailing Address - Phone:801-687-5417
Mailing Address - Fax:801-375-4241
Practice Address - Street 1:1425 S 550 E
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84097-7136
Practice Address - Country:US
Practice Address - Phone:801-717-9162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-30
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT954093035011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical