MEDICARE: MICHELLE MOYES LPC

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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center	347866-6004	UT
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1639492036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE MOYES LPC

Provider Business Mailing Address
First Line	:	3725 W 4100 S STE 201
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84120-5427
Country	:	US
Telephone Number	:	888-949-4864
Fax Number	:	801-468-2006

Provider Business Practice Location Address
First Line	:	3725 W 4100 S
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84120-5411
Country	:	US
Telephone Number	:	888-949-4864
Fax Number	:	801-468-2006

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

Provider Enumeration Date	:	03/12/2010
Last Update Date	:	03/20/2024

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Directions to “ MICHELLE MOYES LPC” Practice Location

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