Individual
BENJAMIN VIRLOW MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CSW
Contact information
Practice address
575 EAST 100 SOUTH, PRICE, UT 84501
(435) 637-2358
(435) 637-9141
Mailing address
PO BOX 867, 105 WEST 100 NORTH, PRICE, UT 84501
(435) 637-7200
(435) 637-2377
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
6396608-3502
UT
Other
Enumeration date
06/11/2010
Last updated
06/11/2010
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