Healthcare Provider Details

I. General information

NPI: 1730782038
Provider Name (Legal Business Name): TINA SPENDLOVE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2020
Last Update Date: 11/18/2020
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 S PROVIDENCE CENTER DR STE 2
CEDAR CITY UT
84720-1981
US

IV. Provider business mailing address

3823 S OLD HIGHWAY 91
NEW HARMONY UT
84757-5179
US

V. Phone/Fax

Practice location:
  • Phone: 435-586-4479
  • Fax:
Mailing address:
  • Phone: 435-225-4117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

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: