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NPI Code Detail

MEDICARE: MR. GEORGE ALFRED LEBOEUF III LCSW, LMT

MEDICARE: MR. GEORGE ALFRED LEBOEUF III LCSW, LMT
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
11041C0700XClinical Social WorkerSWB-2025-1293NM
21041C0700XClinical Social Worker16063CT
31041C0700XClinical Social Worker13946847-3501UT
4225700000XMassage Therapist13946847-4701UT

General Provider Information

NPI Number : 1194560615
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. GEORGE ALFRED LEBOEUF III LCSW, LMT
Provider Business Mailing Address
First Line : 57 W 9000 S # 104
Second Line :
City : SANDY
State : UT
Zip : 84070-2008
Country : US
Telephone Number : 385-722-4431
Fax Number : 844-835-0202
Provider Business Practice Location Address
First Line : 57 W 9000 S STE 104
Second Line :
City : SANDY
State : UT
Zip : 84070-2008
Country : US
Telephone Number : 385-722-4431
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/26/2024
Last Update Date : 04/13/2026

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