| B. Shane Harmon Lcsw, Llc | |
|
5149 S 1500 W Riverdale UT 84405-3926 | |
| (801) 475-0402 | |
| (801) 475-7464 |
| Full Name | B. Shane Harmon Lcsw, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 5149 S 1500 W, Riverdale, Utah |
| Authorized Official Name and Position | B. Shane Harmon (MANAGER) |
| Authorized Official Contact | 8014750402 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| B. Shane Harmon Lcsw, Llc 5149 S 1500 W Riverdale UT 84405-3926 Ph: (801) 475-0402 | B. Shane Harmon Lcsw, Llc 5149 S 1500 W Riverdale UT 84405-3926 Ph: (801) 475-0402 |
| NPI Number | 1326326273 |
|---|---|
| Provider Enumeration Date | 07/26/2011 |
| Last Update Date | 07/26/2011 |
| Medicare PECOS PAC ID | 8729257431 |
|---|---|
| Medicare Enrollment ID | O20110815000900 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326326273 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 141805-3501 (Utah) | Primary |
| Provider Name | Bart S Harmon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1700882172 PECOS PAC ID: 7315044617 Enrollment ID: I20070522000170 |
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