Provider Demographics
NPI:1386895761
Name:PACKER, LYNELL SOUTH (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LYNELL
Middle Name:SOUTH
Last Name:PACKER
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 1:2317 N HILL FIELD RD STE 103
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-4782
Mailing Address - Country:US
Mailing Address - Phone:801-525-4645
Mailing Address - Fax:801-779-7808
Practice Address - Street 1:2317 N HILL FIELD RD STE 103
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-4782
Practice Address - Country:US
Practice Address - Phone:801-525-4645
Practice Address - Fax:801-779-7808
Is Sole Proprietor?:No
Enumeration Date:2008-10-03
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4817282-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical