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General NPI Number Information
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NPI Number | 1669038352
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Entity Type | Individual
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Provider Name | KASI MICHELLE GOOD LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/17/2019
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Last Update Date | 11/17/2024
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Provider Practice Location Address
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Address Line | 437 E 1000 S STE 200
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City | PLEASANT GROVE
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State | UT
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Zip | 84062-3623
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Country | US
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Telephone | 801-921-3619
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Fax | 801-373-0639
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Provider Business Mailing Address
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Address Line | 3458 W 1420 N
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City | PROVO
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State | UT
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Zip | 84601-6206
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Country | US
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Telephone | 801-636-5321
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 11168100-3502
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License Number State | UT
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