Healthcare Provider Details

I. General information

NPI: 1972801777
Provider Name (Legal Business Name): PAUL MCGARRY LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2011
Last Update Date: 03/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15620 N. 8500 E.
SPRING CITY UT
84662
US

IV. Provider business mailing address

21360 N. 1450 E.
MORONI UT
84646
US

V. Phone/Fax

Practice location:
  • Phone: 435-462-5704
  • Fax: 435-462-5703
Mailing address:
  • Phone: 435-462-5704
  • Fax: 435-462-5703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number130320-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: