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General NPI Number Information
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NPI Number | 1912329939
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Entity Type | Individual
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Provider Name | ALLEN STAYNER RICHARDS LCSW (9/2016)
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Gender | Male
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Dates
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Enumeration Date | 01/09/2014
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Last Update Date | 03/28/2018
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Provider Practice Location Address
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Address Line | 640 E 700 S STE 205B
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City | SAINT GEORGE
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State | UT
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Zip | 84770-5773
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Country | US
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Telephone | 435-817-9780
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Fax |
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Provider Business Mailing Address
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Address Line | 2177 ALLISON ROW
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City | ST GEORGE
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State | UT
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Zip | 84790-8306
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Country | US
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Telephone | 435-773-8909
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | MSW 2ND YEAR INTERN
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 9068997-3501
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License Number State | UT
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