Provider Demographics
NPI:1740905678
Name:ROTH, STEVEN ANDREW (LCSW)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:ANDREW
Last Name:ROTH
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 1:784 S RIVER RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-4712
Mailing Address - Country:US
Mailing Address - Phone:385-208-6197
Mailing Address - Fax:
Practice Address - Street 1:1223 S 620 W
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-3324
Practice Address - Country:US
Practice Address - Phone:385-208-6197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-04
Last Update Date:2024-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12810555-35011041C0700X, 104100000X
UT12810555-3502104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical