Provider Demographics
NPI:1801493382
Name:MOUNT, MAXWELL MARSHALL (LCSW)
Entity type:Individual
Prefix:
First Name:MAXWELL
Middle Name:MARSHALL
Last Name:MOUNT
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 1:249 RODEO DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-9472
Mailing Address - Country:US
Mailing Address - Phone:801-232-4942
Mailing Address - Fax:
Practice Address - Street 1:249 RODEO DR
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:UT
Practice Address - Zip Code:84663-9472
Practice Address - Country:US
Practice Address - Phone:801-232-4942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-07
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10746042-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical