Provider Demographics
NPI:1205436383
Name:SIMISTER, DOROTHY (LCSW)
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:
Last Name:SIMISTER
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:PO BOX 595
Mailing Address - Street 2:
Mailing Address - City:EPHRAIM
Mailing Address - State:UT
Mailing Address - Zip Code:84627-0595
Mailing Address - Country:US
Mailing Address - Phone:435-283-4690
Mailing Address - Fax:
Practice Address - Street 1:805 S 500 W
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-3203
Practice Address - Country:US
Practice Address - Phone:801-465-2852
Practice Address - Fax:435-283-4689
Is Sole Proprietor?:No
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10842028-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical