Healthcare Provider Details

I. General information

NPI: 1982319646
Provider Name (Legal Business Name): HARGROVE BOWLES LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2023
Last Update Date: 01/17/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

532 E 800 N
OREM UT
84097-4146
US

IV. Provider business mailing address

1848 SKYLINE DR
OREM UT
84097-2387
US

V. Phone/Fax

Practice location:
  • Phone: 323-270-8592
  • Fax:
Mailing address:
  • Phone: 323-270-8592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10927754-3501
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: