Provider Demographics
NPI:1013233345
Name:MOORE, JEFFREY SCOTT (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:SCOTT
Last Name:MOORE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1637 E 1470 S
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84404-6087
Mailing Address - Country:US
Mailing Address - Phone:801-540-8054
Mailing Address - Fax:
Practice Address - Street 1:430 E 450 S
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:UT
Practice Address - Zip Code:84015-1736
Practice Address - Country:US
Practice Address - Phone:801-540-8054
Practice Address - Fax:801-776-4162
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-12
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT62297335011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical