Provider Demographics
NPI:1487721841
Name:WHITEHEAD, DEX (LCSW)
Entity type:Individual
Prefix:
First Name:DEX
Middle Name:
Last Name:WHITEHEAD
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:SUNDANCE BEHAVIORAL RESOURCES
Mailing Address - Street 2:845 EAST 4800 SOUTH, SUITE 200
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-5041
Mailing Address - Country:US
Mailing Address - Phone:801-264-9522
Mailing Address - Fax:801-265-9604
Practice Address - Street 1:SUNDANCE BEHAVIORAL RESOURCES
Practice Address - Street 2:845 EAST 4800 SOUTH, SUITE 200
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5041
Practice Address - Country:US
Practice Address - Phone:801-264-9522
Practice Address - Fax:801-265-9604
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT137284-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1326157355Medicare UPIN