Healthcare Provider Details

I. General information

NPI: 1154202828
Provider Name (Legal Business Name): ZACHARY BALE LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2025
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 E PALISADES CIR
IVINS UT
84738-6767
US

IV. Provider business mailing address

819 E PALISADES CIR
IVINS UT
84738-6767
US

V. Phone/Fax

Practice location:
  • Phone: 801-580-7469
  • Fax:
Mailing address:
  • Phone: 801-580-7469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6634395-3501
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: