Provider Demographics
NPI:1104619287
Name:MOYSH, GRACIE MARIE
Entity type:Individual
Prefix:
First Name:GRACIE
Middle Name:MARIE
Last Name:MOYSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 E 690 S
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84335-4800
Mailing Address - Country:US
Mailing Address - Phone:435-851-5410
Mailing Address - Fax:
Practice Address - Street 1:231 N MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:UT
Practice Address - Zip Code:84312-9369
Practice Address - Country:US
Practice Address - Phone:435-851-5410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-22
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst