Individual
MR. CLARK RANDY POWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.C.S.W.
Contact information
Practice address
21260 NORTH 1450 EAST, MORONI, UT 84646-0383
(435) 851-6821
Mailing address
21260 NORTH 1450 EAST, MORONI, UT 84646-0383
(435) 851-6821
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
139432-3501
UT
Other
Enumeration date
07/19/2010
Last updated
07/19/2010
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