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NPI Code Detail

MEDICARE: DAVID EDDY LCSW

MEDICARE: DAVID EDDY LCSW
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 Worker358164-3501UT

General Provider Information

NPI Number : 1639239916
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID EDDY LCSW
Provider Business Mailing Address
First Line : 474 W 200 N STE 300
Second Line :
City : ST GEORGE
State : UT
Zip : 84770-4505
Country : US
Telephone Number : 435-634-5600
Fax Number : 435-986-8702
Provider Business Practice Location Address
First Line : 245 E 680 S
Second Line :
City : CEDAR CITY
State : UT
Zip : 84720-3593
Country : US
Telephone Number : 435-867-7654
Fax Number : 435-867-7699
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/09/2006
Last Update Date : 01/28/2013

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Directions to “ DAVID EDDY LCSW” Practice Location

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