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Individual

MARK D DEVOE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LCSW

Contact information

Practice address
982 CHAMBERS ST, SOUTH OGDEN, UT 84403-4571
(801) 479-4105
Mailing address
4007 IVY AVENUE, MOUNTAIN GREEN, UT 84050
(801) 821-0663

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
8331538-3501
UT
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
260022408
RAILROAD MEDICARE
UT
05
876000308007
UT
Enumeration date
05/18/2011
Last updated
07/19/2017
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