Individual
JACK ALAN GIFT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
313 W CONCORD DR, HARRISVILLE, UT 84404-2745
(801) 814-7943
Mailing address
313 W CONCORD DR, HARRISVILLE, UT 84404-2745
(801) 814-7943
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
75672796005
UT
104100000X
Social Worker
7567279-3502
UT
1041C0700X
Clinical Social Worker
Primary
7567279-3501
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7567279-3501
LCSW LICENSE
UT
Enumeration date
01/13/2011
Last updated
07/11/2022
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