Healthcare Provider Details

I. General information

NPI: 1336230911
Provider Name (Legal Business Name): MICHELLE RUTH MORAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 04/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

474 W. 200 NORTH, STE 200 SOUTHWEST BEHAVIORAL HEALTH CENTER
SAINT GEORGE UT
84770
US

IV. Provider business mailing address

PO BOX 820387
VEYO UT
84782-0387
US

V. Phone/Fax

Practice location:
  • Phone: 435-634-5600
  • Fax:
Mailing address:
  • Phone: 719-439-4363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number7964A
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number7964A
License Number StateWY
# 3
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number8052247-1205
License Number StateUT
# 4
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number8052247-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: