Provider Demographics
NPI:1689420119
Name:VAN ZANT, JOSEPH BINGHAM (LCSW)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:BINGHAM
Last Name:VAN ZANT
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 1:12453 S MAYAN ST
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84096-2478
Mailing Address - Country:US
Mailing Address - Phone:480-415-7704
Mailing Address - Fax:
Practice Address - Street 1:12453 S MAYAN ST
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84096-2478
Practice Address - Country:US
Practice Address - Phone:480-415-7704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13340713-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical