Provider Demographics
NPI:1336488428
Name:TRICE, CHARLES WAYNE JR (MSW)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:WAYNE
Last Name:TRICE
Suffix:JR
Gender:M
Credentials:MSW
Other - Prefix:MR
Other - First Name:WAYNE
Other - Middle Name:
Other - Last Name:TRICE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW
Mailing Address - Street 1:1381 E MILLSTREAM LN
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-2921
Mailing Address - Country:US
Mailing Address - Phone:801-550-3486
Mailing Address - Fax:
Practice Address - Street 1:5770 S 1500 W
Practice Address - Street 2:C
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84123-5216
Practice Address - Country:US
Practice Address - Phone:801-313-7940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-08
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT128276-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical