Basic Information
| Provider Information | |||||||||
| NPI: | 1790879625 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARRUS | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | WALDEN | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 904 SOUTH STATE STREET | ||||||||
| Address2: | |||||||||
| City: | CLEARFIELD | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840151677 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8017768600 | ||||||||
| FaxNumber: | 8017762720 | ||||||||
| Practice Location | |||||||||
| Address1: | 2250 SOUTH 1700 WEST BUILDING A | ||||||||
| Address2: | |||||||||
| City: | LAYTON | ||||||||
| State: | UT | ||||||||
| PostalCode: | 84041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8017737060 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 12/02/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 6221757-3502 | UT | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.