Healthcare Provider Details

I. General information

NPI: 1184688012
Provider Name (Legal Business Name): RENE ELIAS BARRERA LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8813 S REDWOOD RD STE B1
WEST JORDAN UT
84088-9272
US

IV. Provider business mailing address

8813 S REDWOOD RD STE B1
WEST JORDAN UT
84088-9272
US

V. Phone/Fax

Practice location:
  • Phone: 385-439-9823
  • Fax:
Mailing address:
  • Phone: 385-439-9823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7447256-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: