NPIMap

Individual provider Active NPI

Paul Joseph Peterson, MSW

  • Social Worker
  • Bountiful, UT
National Provider Identifier
1528114667
Registry record updated Sep 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
5388245-3501 Issued in UT
Practice address
1459 N Main St Ste 100
Bountiful, UT 84010-6092
Phone
(801) 298-2000
Fax
(801) 951-1490
NPI assigned
Jan 25, 2007
Last updated
Sep 23, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 5388245-3501 UT Primary
Clinical Social Worker 1041C0700X 5388245-3501 UT

Addresses

Primary practice location

1459 N Main St Ste 100
Bountiful, UT 84010-6092

Mailing address

1459 N Main St Ste 100
Bountiful, UT 84010-6092
Phone (801) 298-2000

Other practice location 1

11260 S River Heights Drive
South Jordan, UT 84095
Phone (801) 298-2000

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
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.
Opted out of Medicare
Yes, effective Jul 1, 2026 through Jul 1, 2028

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5388245-3501UTMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Ocd Anxiety Centers Colorado LLC Current Accepting new patients
The Ocd and Anxiety Treatment Center Clinical CurrentSince Oct 25, 2020 Accepting new patients
Ocd Anxiety Centers Utah LLC PastSince Oct 19, 2020 Accepting new patients
The Counseling Center LLC Past Accepting new patients
Counseling Center LLC PastSince Oct 2, 2009 Accepting new patients

Locations

1459 N Main St
Ste 100
Bountiful, UT 84010
Phone (801) 298-2000

386 N Main St
Centerville, UT 84014
Phone (801) 298-2000

11260 S River Heights Dr
South Jordan, UT 84095
Phone (385) 308-8403

Organizations & group practices 19

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.

View all 19

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727049600000",
    "number": "1528114667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1459 N MAIN ST STE 100",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840106092",
            "telephone_number": "801-298-2000",
            "fax_number": "801-951-1490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1459 N MAIN ST STE 100",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840106092",
            "telephone_number": "801-298-2000",
            "fax_number": "801-951-1490"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11260 S RIVER HEIGHTS DRIVE",
            "address_purpose": "LOCATION",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "84095",
            "country_code": "US",
            "telephone_number": "801-298-2000",
            "fax_number": "801-951-1490",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "PAUL",
        "middle_name": "JOSEPH",
        "name_prefix": "Mr.",
        "credential": "MSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-25",
        "last_updated": "2024-09-23",
        "certification_date": "2024-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "UT",
            "license": "5388245-3501",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "UT",
            "license": "5388245-3501",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bountiful, UT

Sources for this page

Verify at the official NPI Registry.