Healthcare Provider Details

I. General information

NPI: 1093006348
Provider Name (Legal Business Name): LORRIE MICHELLE BELNAP L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2011
Last Update Date: 07/22/2022
Certification Date: 07/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 E MYRTLE AVE STE 204
MURRAY UT
84107-4850
US

IV. Provider business mailing address

154 E MYRTLE AVE STE 204
MURRAY UT
84107-4850
US

V. Phone/Fax

Practice location:
  • Phone: 801-369-8989
  • Fax: 801-704-9741
Mailing address:
  • Phone: 801-369-8989
  • Fax: 801-704-9741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number293589-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: