Provider Demographics
NPI:1962728964
Name:HARTMAN, TROY (LCSW)
Entity type:Individual
Prefix:
First Name:TROY
Middle Name:
Last Name:HARTMAN
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:PO BOX 107
Mailing Address - Street 2:
Mailing Address - City:BRIGHAM CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84302-0107
Mailing Address - Country:US
Mailing Address - Phone:435-730-7527
Mailing Address - Fax:
Practice Address - Street 1:693 S 400 E
Practice Address - Street 2:
Practice Address - City:BRIGHAM CITY
Practice Address - State:UT
Practice Address - Zip Code:84302-2924
Practice Address - Country:US
Practice Address - Phone:435-730-6167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-15
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5712144-35011041C0700X, 253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No253J00000XAgenciesFoster Care Agency