Provider Demographics
NPI:1083929251
Name:HARDING, BENJAMIN TIMOTHY (LCSW)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:TIMOTHY
Last Name:HARDING
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 1:437 S BLUFF ST STE 302
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-3591
Mailing Address - Country:US
Mailing Address - Phone:435-634-8848
Mailing Address - Fax:
Practice Address - Street 1:437 S BLUFF ST STE 102
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3553
Practice Address - Country:US
Practice Address - Phone:435-634-8848
Practice Address - Fax:435-634-8884
Is Sole Proprietor?:No
Enumeration Date:2010-08-12
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1026962535011041C0700X
UT390200000X
AZLCSW-156291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT102696253501OtherLICENSED CLINICAL SOCIAL WORKER
AZLCSW-15629OtherLICENSED CLINICAL SOCIAL WORKER