Provider Demographics
NPI:1437398427
Name:CAMMACK, EARL M JR (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:EARL
Middle Name:M
Last Name:CAMMACK
Suffix:JR
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4484 S. 1900 WEST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:ROY
Mailing Address - State:UT
Mailing Address - Zip Code:84067
Mailing Address - Country:US
Mailing Address - Phone:801-732-1222
Mailing Address - Fax:801-732-1222
Practice Address - Street 1:4484 SO. 1900 WEST
Practice Address - Street 2:SUITE 6
Practice Address - City:ROY
Practice Address - State:UT
Practice Address - Zip Code:84067
Practice Address - Country:US
Practice Address - Phone:801-732-1222
Practice Address - Fax:801-689-7199
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-13
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT269749-3501101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor