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Individual provider · Clinical Social Worker · Hill Air Force Base, UT

NPI
1023564051
Type
Individual (Type 1)
Primary specialty
Clinical Social Worker (Social Worker)
Specialty group
Behavioral Health & Social Service Providers
Taxonomy code
1041C0700X
License number
10859794-3501 (UT)
Sex
Male
Sole proprietor
Yes
Enumerated
2016-08-30
Last updated
2023-04-11
Practice location
7321 Balmer St Bldg 545
Hill Air Force Base, UT 84056-5012
(801) 777-7909

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