Provider Demographics
NPI:1538149141
Name:SCOVILLE, BARBARA ANN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:ANN
Last Name:SCOVILLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9729 SWEET BLOSSOM DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-3217
Mailing Address - Country:US
Mailing Address - Phone:801-253-3606
Mailing Address - Fax:
Practice Address - Street 1:5635 SOUTH WATERBURY WAY
Practice Address - Street 2:SUITE C-202
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121
Practice Address - Country:US
Practice Address - Phone:801-278-0200
Practice Address - Fax:801-273-0320
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4927001-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT107018310101OtherINTERMOUNTAIN HEALTHCARE
UTQO7203OtherICAR
UT49270013501Medicaid
UT802653OtherDESERET MUTUAL
UT942938348BS1OtherEDUCATORS MUTUAL
UT942938348003OtherCHAMPUS