Healthcare Provider Details

I. General information

NPI: 1306882972
Provider Name (Legal Business Name): ALAN G. NELL LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 W 100 N
EPHRAIM UT
84627-2131
US

IV. Provider business mailing address

255 W MAIN ST
MT PLEASANT UT
84647-1331
US

V. Phone/Fax

Practice location:
  • Phone: 435-283-4065
  • Fax: 435-283-5387
Mailing address:
  • Phone: 435-462-2416
  • Fax: 435-462-9350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number265553-3501
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: