Active NPI
Lateisha Lynn Golub
- Clinical Social Worker
- Sandy, UT
National Provider Identifier
1326474446
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 89741963501
- Practice address
- 9176 S 300 W
Sandy, UT 84070-2668 - Phone
- (801) 520-5749
- Fax
- (801) 478-5869
- NPI assigned
- Sep 20, 2013
- Last updated
- Feb 14, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 89741963501 | UT | Primary |
Addresses
Primary practice location
9176 S 300 W
Sandy, UT 84070-2668
Mailing address
4000 S 700 E Ste 9
Salt Lake City, UT 84107-2581
Phone (801) 639-9544
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326474446 | Medicaid | UT |
Other names 1
- Lateisha L Johnson
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Apr 1, 2024 through Apr 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 89741963501 | UT | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wide Mind Wellness, LLC | Clinical | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Clinical Social Worker
- South Jordan, UT
- NPI 1598242893
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1379635200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1581638400000",
"number": "1326474446",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4000 S 700 E STE 9",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841072581",
"telephone_number": "801-639-9544"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9176 S 300 W",
"city": "SANDY",
"state": "UT",
"postal_code": "840702668",
"telephone_number": "801-520-5749",
"fax_number": "801-478-5869"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOLUB",
"first_name": "LATEISHA",
"middle_name": "LYNN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-09-20",
"last_updated": "2020-02-14",
"certification_date": "2020-02-14",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "UT",
"license": "89741963501",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1326474446",
"state": "UT"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "LATEISHA",
"last_name": "JOHNSON",
"middle_name": "L",
"credential": "LCSW",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Sandy, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.