Provider Demographics
NPI:1063595098
Name:HARLEY, PAUL DAVID (MSW)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:DAVID
Last Name:HARLEY
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 W 650 N
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84015-3712
Mailing Address - Country:US
Mailing Address - Phone:801-779-4913
Mailing Address - Fax:
Practice Address - Street 1:807 E SOUTH TEMPLE STE 370
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1351
Practice Address - Country:US
Practice Address - Phone:801-521-0182
Practice Address - Fax:801-521-0196
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS227271041C0700X
CA22727 LCSW1041C0700X
NV117-C LCSW1041C0700X
NV0275 MFT106H00000X
UT7118299-3502 CSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT7118299-3502 CSWOtherDOPL UTAH
CALCS22727OtherLCSW LICENSE
NVLCSW 117-COtherBOARD OF EXAMINERS OF SOCIAL WORKERS
NVMFT 0275OtherBOARD OF EXAMINERS OF MFT