| Wasatch Front Trail Venture | |
|
61 E 1600 N Genola UT 84655-5090 | |
| (435) 513-2715 | |
| Not Available |
| Full Name | Wasatch Front Trail Venture |
|---|---|
| Speciality | Social Worker |
| Location | 61 E 1600 N, Genola, Utah |
| Authorized Official Name and Position | Morgan Gonzales (PROVIDER) |
| Authorized Official Contact | 4355132715 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wasatch Front Trail Venture 61 E 1600 N Genola UT 84655-5090 Ph: () - | Wasatch Front Trail Venture 61 E 1600 N Genola UT 84655-5090 Ph: (435) 513-2715 |
| NPI Number | 1407464886 |
|---|---|
| Provider Enumeration Date | 07/21/2020 |
| Last Update Date | 07/21/2020 |
| Certification Date | 07/21/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407464886 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 104100000X | Social Worker | (* (Not Available)) | Primary |
Gonzales Lcsw Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 61 E 1600 N, Genola, UT 84655 Phone: 385-434-1274 |