Healthcare Provider Details

I. General information

NPI: 1184024796
Provider Name (Legal Business Name): DUSTIN JAY HALL LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2014
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

537 W 2600 S STE 203
BOUNTIFUL UT
84010-7780
US

IV. Provider business mailing address

537 W 2600 S STE 203
BOUNTIFUL UT
84010-7780
US

V. Phone/Fax

Practice location:
  • Phone: 801-833-4443
  • Fax: 385-399-0032
Mailing address:
  • Phone: 801-833-4443
  • Fax: 385-399-0032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9448720-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: