Provider Demographics
NPI:1245538545
Name:GORTON, SAMUEL JOSEPH (CMHC)
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:JOSEPH
Last Name:GORTON
Suffix:
Gender:M
Credentials:CMHC
Other - Prefix:
Other - First Name:JOE
Other - Middle Name:
Other - Last Name:GORTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CMHC
Mailing Address - Street 1:798 COUNTRY CLB
Mailing Address - Street 2:
Mailing Address - City:STANSBURY PARK
Mailing Address - State:UT
Mailing Address - Zip Code:84074-9624
Mailing Address - Country:US
Mailing Address - Phone:801-661-6571
Mailing Address - Fax:
Practice Address - Street 1:5965 S 900 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-1720
Practice Address - Country:US
Practice Address - Phone:801-263-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-10
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6815649-3503101YM0800X
COLPC.0020480101YP2500X
UT6815649-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional