Individual
RICHARD LEE WAILES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
2096 ARTHUR DR, WEST JORDAN, UT 84084-3237
(801) 808-1072
(866) 882-3907
Mailing address
2096 ARTHUR DR, WEST JORDAN, UT 84084-3237
(801) 808-1072
(866) 882-3907
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
324302-3501
UT
Other
Enumeration date
12/29/2006
Last updated
11/04/2007
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