MEDICARE: MR. PAUL DAVID HARLEY MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LCS22727	CA
2	1041C0700X	Clinical Social Worker	22727 LCSW	CA
3	1041C0700X	Clinical Social Worker	117-C LCSW	NV
4	106H00000X	Marriage & Family Therapist	0275 MFT	NV
5	1041C0700X	Clinical Social Worker	7118299-3502 CSW	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7118299-3502 CSW	OTHER	UT	DOPL UTAH
2	LCS22727	OTHER	CA	LCSW LICENSE
3	LCSW 117-C	OTHER	NV	BOARD OF EXAMINERS OF SOCIAL WORKERS
4	MFT 0275	OTHER	NV	BOARD OF EXAMINERS OF MFT

General Provider Information

NPI Number	:	1063595098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PAUL DAVID HARLEY MSW

Provider Business Mailing Address
First Line	:	221 W 650 N
Second Line	:
City	:	CLEARFIELD
State	:	UT
Zip	:	84015-3712
Country	:	US
Telephone Number	:	801-779-4913
Fax Number	:

Provider Business Practice Location Address
First Line	:	807 E SOUTH TEMPLE STE 370
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-1351
Country	:	US
Telephone Number	:	801-521-0182
Fax Number	:	801-521-0196

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	11/17/2009

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