Provider Demographics
NPI:1295903037
Name:TABISH, JOSEPH HENRY (LCSW)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:HENRY
Last Name:TABISH
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 1:3378 SOUTH 900 EAST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-2070
Mailing Address - Country:US
Mailing Address - Phone:801-463-7520
Mailing Address - Fax:801-463-7525
Practice Address - Street 1:3378 SOUTH 900 EAST
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-2070
Practice Address - Country:US
Practice Address - Phone:801-463-7520
Practice Address - Fax:801-463-7525
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-14
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT139727-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT005569802OtherMEDICARE A
UT5286974304001OtherBLUE CROSS BLUE SHIELD