Provider Demographics
NPI:1528114667
Name:PETERSON, PAUL JOSEPH (MSW)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:JOSEPH
Last Name:PETERSON
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1459 N MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-6092
Mailing Address - Country:US
Mailing Address - Phone:801-298-2000
Mailing Address - Fax:801-951-1490
Practice Address - Street 1:1459 N MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-6092
Practice Address - Country:US
Practice Address - Phone:801-298-2000
Practice Address - Fax:801-951-1490
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5388245-35011041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical