Provider Demographics
NPI:1386938751
Name:CHIDESTER, ALAN RUSHBY (LCSW)
Entity type:Individual
Prefix:MR
First Name:ALAN
Middle Name:RUSHBY
Last Name:CHIDESTER
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 1:1435 VINEYARD CIR
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-8800
Mailing Address - Country:US
Mailing Address - Phone:801-455-4089
Mailing Address - Fax:
Practice Address - Street 1:3135 N FAIRFIELD RD STE A
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-8832
Practice Address - Country:US
Practice Address - Phone:801-771-9099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-02
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5935746-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical