Provider Demographics
NPI:1720257314
Name:HAGGETT, BETH ANN (LCSW, PHD)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:ANN
Last Name:HAGGETT
Suffix:
Gender:F
Credentials:LCSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 E MAIN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MIDWAY
Mailing Address - State:UT
Mailing Address - Zip Code:84049-6806
Mailing Address - Country:US
Mailing Address - Phone:435-657-1777
Mailing Address - Fax:435-657-0098
Practice Address - Street 1:210 E MAIN ST
Practice Address - Street 2:SUITE 108
Practice Address - City:MIDWAY
Practice Address - State:UT
Practice Address - Zip Code:84049-6806
Practice Address - Country:US
Practice Address - Phone:435-657-1777
Practice Address - Fax:435-657-0098
Is Sole Proprietor?:No
Enumeration Date:2008-02-27
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT680857735011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical