Healthcare Provider Details

I. General information

NPI: 1275158974
Provider Name (Legal Business Name): MAGNUM MORGAN LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2020
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 N MAIN ST STE 105
CEDAR CITY UT
84721-7807
US

IV. Provider business mailing address

2088 N HAWTHORNE LN
CEDAR CITY UT
84721-7713
US

V. Phone/Fax

Practice location:
  • Phone: 435-688-1111
  • Fax: 435-688-8488
Mailing address:
  • Phone: 801-885-3458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number9640257-3902
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number9640257-3904
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: