Healthcare Provider Details

I. General information

NPI: 1114447067
Provider Name (Legal Business Name): TAWNY J THOMAS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 06/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

491 S MAIN ST STE 201
CEDAR CITY UT
84720-3470
US

IV. Provider business mailing address

343 N BEACON DR
CEDAR CITY UT
84720-6937
US

V. Phone/Fax

Practice location:
  • Phone: 435-890-9180
  • Fax:
Mailing address:
  • Phone: 435-890-9180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number376470-3501
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: