Provider Demographics
NPI:1295807378
Name:OTT, JAMES KEVIN (LCSW)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:KEVIN
Last Name:OTT
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 1:1425 S 700 E STE 102
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84105-2125
Mailing Address - Country:US
Mailing Address - Phone:801-556-6007
Mailing Address - Fax:801-410-4405
Practice Address - Street 1:1425 S 700 E STE 102
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84105-2125
Practice Address - Country:US
Practice Address - Phone:801-556-6007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT116648-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical