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NPI Code Detail

MEDICARE: BROCK B ALDER LCSW

MEDICARE: BROCK B ALDER 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 WorkerLCSW-875ID
2101YA0400XAddiction (Substance Use Disorder) Counselor139698-3501UT

General Provider Information

NPI Number : 1689753774
Entity Type Code : Individual
Provider Name (Legal Business Name) : BROCK B ALDER LCSW
Provider Business Mailing Address
First Line : 655 E 1300 N
Second Line :
City : LOGAN
State : UT
Zip : 84341-2570
Country : US
Telephone Number : 435-792-6500
Fax Number :
Provider Business Practice Location Address
First Line : 655 E 1300 N
Second Line :
City : LOGAN
State : UT
Zip : 84341-2570
Country : US
Telephone Number : 435-792-6500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2006
Last Update Date : 03/07/2023

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Directions to “ BROCK B ALDER LCSW” Practice Location

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