Organization
LOOSE CANNON SOCIAL WORK, LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRUCE CRAIG SOLOMON LCSW (MANAGER)
(801) 652-4437
Entity
Organization
Contact information
Practice address
2298 E 200 S, SAINT GEORGE, UT 84790-1603
(801) 652-4437
Mailing address
2298 E 200 S, SAINT GEORGE, UT 84790-1603
(801) 652-4437
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
8202232-3501
UT
Other
Enumeration date
10/04/2016
Last updated
10/04/2016
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