Provider Demographics
NPI:1104132372
Name:WORLTON, JON R (LCSW)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:R
Last Name:WORLTON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:JON
Other - Middle Name:
Other - Last Name:WORTLON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:4626 N 300 W STE 150
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-6077
Mailing Address - Country:US
Mailing Address - Phone:435-688-2123
Mailing Address - Fax:801-877-0864
Practice Address - Street 1:393 E RIVERSIDE DR STE 3A
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-7127
Practice Address - Country:US
Practice Address - Phone:435-688-2123
Practice Address - Fax:801-877-0864
Is Sole Proprietor?:No
Enumeration Date:2010-08-26
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14105635011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical