Individual
MR. LUCAS JAMES MOULTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW, CRC, LVRC
Contact information
Practice address
1358 PROVO SLOUGH ACCESS RD, OREM, UT 84058
(801) 373-1197
Mailing address
1358 PROVO SLOUGH ACCESS RD, OREM, UT 84058
(801) 373-1197
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
7126504-3501
UT
Other
Enumeration date
03/13/2012
Last updated
03/13/2012
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