Healthcare Provider Details

I. General information

NPI: 1861921462
Provider Name (Legal Business Name): LISA ANTOINETTE TEMPLE LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2017
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

172 E 14075 S STE 110
DRAPER UT
84020-5725
US

IV. Provider business mailing address

16063 S TRUSS DR
BLUFFDALE UT
84065-1867
US

V. Phone/Fax

Practice location:
  • Phone: 888-588-8995
  • Fax:
Mailing address:
  • Phone: 801-979-9404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number6543517-3902
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: