Basic Information
| Provider Information | |||||||||
| NPI: | 1659931921 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALLRED | ||||||||
| FirstName: | DESREE | ||||||||
| MiddleName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1140 W 500 S STE 9 | ||||||||
| Address2: | |||||||||
| City: | VERNAL | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840782912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4357896300 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1140 W 500 S STE 9 | ||||||||
| Address2: | |||||||||
| City: | VERNAL | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840782912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4357896300 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2019 | ||||||||
| LastUpdateDate: | 10/20/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 68496743503 | UT | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | 6849674-3501 | UT | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.