Individual
KELLY MIKE GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSW, LCSW
Contact information
Practice address
LDS FAMILY SERVICES, 630 W PRICE RIVER DR., PRICE, UT 84501
(435) 637-2991
Mailing address
427 E 100 N, MOAB, UT 84532-2409
(435) 259-5500
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
130900-3501
UT
Other
Enumeration date
05/03/2007
Last updated
07/08/2007
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