Provider Demographics
NPI:1154290005
Name:PUCKETT, JULIA (CSW)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:PUCKETT
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:JAY
Other - Middle Name:
Other - Last Name:PUCKETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CSW
Mailing Address - Street 1:124 S 400 E STE 450
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-5306
Mailing Address - Country:US
Mailing Address - Phone:801-467-2863
Mailing Address - Fax:
Practice Address - Street 1:124 S 400 E STE 450
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-5306
Practice Address - Country:US
Practice Address - Phone:801-467-2863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-30
Last Update Date:2025-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14227037-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical