| Organization Name: | MARY BETH WHITTAKER LCSW |
| NPI Number: | 1538538525 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARY BETH WHITTAKER (OWNER) |
| Mailing Address: | 2290 E 4500 S Suite 210 Holladay |
| State: | UT US |
| Postal Code: | 841174492 |
| Phone Number: | 8012723533 |
| Fax Number: | 8012723636 |
| NPI Enumeration Date: | 09/19/2015 |
| NPI Last Update Date: | 09/19/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 130283-3501 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | UT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |