Healthcare Provider Details

I. General information

NPI: 1730656679
Provider Name (Legal Business Name): MICHELLE CASSIA ALBUQUERQUE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE CASSIA BEAMES LCSW

II. Dates (important events)

Enumeration Date: 10/29/2018
Last Update Date: 09/07/2025
Certification Date: 09/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5373 S GREEN ST
MURRAY UT
84123-4680
US

IV. Provider business mailing address

151 W SWAINSON AVE
SARATOGA SPRINGS UT
84045-6461
US

V. Phone/Fax

Practice location:
  • Phone: 801-442-2670
  • Fax:
Mailing address:
  • Phone: 760-608-3818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW103041
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: