Tanner Moffat

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

14006549-3502 Issued in UT

Practice address

3210 N Canyon Rd Ste 204
Provo, UT 84604-5608

Phone

(385) 204-6273

NPI assigned

Jul 9, 2024

Last updated

Jun 4, 2026By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Resurgo Recovery LLC

  • Clinical Social Worker
  • Cedar Hills, UT
  • NPI 1326860305
  NPD Authorized official
• Shiloh Mental Health PLLC

  • Clinical Social Worker
  • Provo, UT
  • NPI 1497698526
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1720483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780531200000",
    "number": "1205672227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3210 N CANYON RD STE 204",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846045608",
            "telephone_number": "385-204-6273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3210 N CANYON RD STE 204",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846045608",
            "telephone_number": "385-204-6273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOFFAT",
        "first_name": "TANNER",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-07-09",
        "last_updated": "2026-06-04",
        "certification_date": "2026-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "UT",
            "license": "14006549-3502",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mobile Physical Therapy Services, LLC
• Modern Shoe, Inc.
• Samantha Moeai, LCSW
• Keilani Leslie Moeaki
• Krosbi Moesinger
• Cristina L Mogos, MD
• Elide Adriana Mojica Williamson
• Chloe Molina
• Ashley Moline
• Hanna Elise Mollerup

• Clinical Social Worker in Provo, UT
• Providers in Provo, UT by specialty
• Clinical Social Worker in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.