Provider Demographics
NPI:1194920991
Name:UNO, TAB L (LCSW)
Entity type:Individual
Prefix:
First Name:TAB
Middle Name:L
Last Name:UNO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 S 1050 W
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84015-8773
Mailing Address - Country:US
Mailing Address - Phone:801-776-9107
Mailing Address - Fax:801-773-5918
Practice Address - Street 1:3518 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-1034
Practice Address - Country:US
Practice Address - Phone:801-399-1600
Practice Address - Fax:801-399-1060
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT520636835011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical