Organization
SUSAN MIDDLETON PHD LCSW CONSULTING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUSAN G MIDDLETON PHD, LCSW (PSYCHOTHERAPIST)
(801) 473-4989
Entity
Organization
Contact information
Practice address
1059 N 700 E, LEHI, UT 84043-1327
(801) 473-4989
Mailing address
1059 N 700 E, LEHI, UT 84043-1327
(801) 473-4989
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11008402-0162
CERTIFICATE OF REGISTRATION LLC - PROFESSIONAL
UT
01
—
139789-3501
LICENSED CLINICAL SOCIAL WORKER
UT
Enumeration date
12/28/2018
Last updated
12/28/2018
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