Healthcare Provider Details

I. General information

NPI: 1083929251
Provider Name (Legal Business Name): BENJAMIN TIMOTHY HARDING LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2010
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

437 S BLUFF ST STE 102
ST GEORGE UT
84770-3553
US

IV. Provider business mailing address

437 S BLUFF ST STE 302
ST GEORGE UT
84770-3591
US

V. Phone/Fax

Practice location:
  • Phone: 435-634-8848
  • Fax: 435-634-8884
Mailing address:
  • Phone: 435-634-8848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number102696253501
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-15629
License Number StateAZ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier102696253501
Identifier TypeOTHER
Identifier StateUT
Identifier IssuerLICENSED CLINICAL SOCIAL WORKER
# 2
IdentifierLCSW-15629
Identifier TypeOTHER
Identifier StateAZ
Identifier IssuerLICENSED CLINICAL SOCIAL WORKER

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: