Provider Demographics
NPI:1457660680
Name:KOFOED, GARETT ARVIN (LCSW)
Entity type:Individual
Prefix:MR
First Name:GARETT
Middle Name:ARVIN
Last Name:KOFOED
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 1:9721 S OIA LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-2309
Mailing Address - Country:US
Mailing Address - Phone:385-228-9511
Mailing Address - Fax:
Practice Address - Street 1:8TH AVE C ST E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84143-3226
Practice Address - Country:US
Practice Address - Phone:801-408-7301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8636089-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical