Active NPI
Lucas James Moulton, LCSW, CRC, LVRC
- Clinical Social Worker
- Orem, UT
National Provider Identifier
1265707038
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 7126504-3501
- Practice address
- 1358 Provo Slough Access Rd
Orem, UT 84058 - Phone
- (801) 373-1197
- NPI assigned
- Mar 13, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 7126504-3501 | UT | Primary |
Addresses
Primary practice location
1358 Provo Slough Access Rd
Orem, UT 84058
Mailing address
1358 Provo Slough Access Rd
Orem, UT 84058
Phone (801) 373-1197
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Oct 1, 2021 through Oct 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rise Behavioral and Mental Health Services, LLC | Past | Accepting new patients | |
| Rise, Inc | Clinical | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- Midvale, UT
- NPI 1447499140
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1331596800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1331596800000",
"number": "1265707038",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1358 PROVO SLOUGH ACCESS RD",
"city": "OREM",
"state": "UT",
"postal_code": "84058",
"telephone_number": "801-373-1197"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1358 PROVO SLOUGH ACCESS RD",
"city": "OREM",
"state": "UT",
"postal_code": "84058",
"telephone_number": "801-373-1197"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOULTON",
"first_name": "LUCAS",
"middle_name": "JAMES",
"name_prefix": "Mr.",
"credential": "LCSW, CRC, LVRC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-03-13",
"last_updated": "2012-03-13",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "UT",
"license": "7126504-3501",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Orem, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.