Healthcare Provider Details

I. General information

NPI: 1104619287
Provider Name (Legal Business Name): GRACIE MARIE MOYSH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2025
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 N MAIN ST STE 200
GARLAND UT
84312-9369
US

IV. Provider business mailing address

146 E 690 S
SMITHFIELD UT
84335-4800
US

V. Phone/Fax

Practice location:
  • Phone: 435-851-5410
  • Fax:
Mailing address:
  • Phone: 435-851-5410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number14285025-2506
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: