Provider Demographics
NPI:1306067459
Name:BLACKWELL, DAVID HOWARTH (LPC, LSAC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:HOWARTH
Last Name:BLACKWELL
Suffix:
Gender:M
Credentials:LPC, LSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11188 N 6000 W
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:UT
Mailing Address - Zip Code:84003-9438
Mailing Address - Country:US
Mailing Address - Phone:801-756-7403
Mailing Address - Fax:
Practice Address - Street 1:11188 N 6000 W
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:UT
Practice Address - Zip Code:84003-9438
Practice Address - Country:US
Practice Address - Phone:801-756-7403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT342505-6004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional