Provider Demographics
NPI:1306333281
Name:SKOUSEN, CRAIG L (LCSW)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:L
Last Name:SKOUSEN
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 1:1630 E 2450 S UNIT 121
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-6234
Mailing Address - Country:US
Mailing Address - Phone:435-668-4983
Mailing Address - Fax:
Practice Address - Street 1:1630 E 2450 S UNIT 121
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-6234
Practice Address - Country:US
Practice Address - Phone:435-668-4983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT130864-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical