Provider Demographics
NPI:1083592760
Name:CLOVER CLINICAL LLC
Entity type:Organization
Organization Name:CLOVER CLINICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:PEARL
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:435-691-5644
Mailing Address - Street 1:692 W 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84701-2434
Mailing Address - Country:US
Mailing Address - Phone:435-691-5644
Mailing Address - Fax:
Practice Address - Street 1:635 N MAIN ST STE 683
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:UT
Practice Address - Zip Code:84701-1895
Practice Address - Country:US
Practice Address - Phone:435-691-5644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-22
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1447070198OtherNPI
1003637901OtherNPI
1033878301OtherNPI