Provider Demographics
NPI:1740381425
Name:MOSSEL, KEVIN (LCSW)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:MOSSEL
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 1:2336 W LONGMEADOW DR
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84129-5803
Mailing Address - Country:US
Mailing Address - Phone:801-968-3319
Mailing Address - Fax:
Practice Address - Street 1:145 E 1300 S
Practice Address - Street 2:SUITE 501
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115-5482
Practice Address - Country:US
Practice Address - Phone:385-468-3465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT369962-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical