Provider Demographics
NPI:1750617791
Name:PROCTOR, LYNDSEY (LCSW)
Entity type:Individual
Prefix:
First Name:LYNDSEY
Middle Name:
Last Name:PROCTOR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LYNDSEY
Other - Middle Name:
Other - Last Name:CRAYK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10367 S OTTER TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84009-2290
Mailing Address - Country:US
Mailing Address - Phone:801-618-7331
Mailing Address - Fax:
Practice Address - Street 1:12447 S CROSSING DR STE 13
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84096-7020
Practice Address - Country:US
Practice Address - Phone:801-984-0184
Practice Address - Fax:801-984-0186
Is Sole Proprietor?:No
Enumeration Date:2009-10-27
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT87-03597191041C0700X
8699899-35011041C0700X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator