Provider Demographics
NPI:1841743135
Name:MOYNIER, DANNETTE H (LCSW)
Entity Type:Individual
Prefix:
First Name:DANNETTE
Middle Name:H
Last Name:MOYNIER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1483 INDEPENDENCE AVE
Mailing Address - Street 2:
Mailing Address - City:PRICE
Mailing Address - State:UT
Mailing Address - Zip Code:84501-7402
Mailing Address - Country:US
Mailing Address - Phone:435-650-3013
Mailing Address - Fax:
Practice Address - Street 1:375 S CARBON AVE
Practice Address - Street 2:
Practice Address - City:PRICE
Practice Address - State:UT
Practice Address - Zip Code:84501-2909
Practice Address - Country:US
Practice Address - Phone:435-650-3013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-03
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT131578-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical