Healthcare Provider Details

I. General information

NPI: 1659650117
Provider Name (Legal Business Name): EPHRAIM K. HANKS LCSW, LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2011
Last Update Date: 07/25/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

677 W 375 S
HURRICANE UT
84737-3250
US

IV. Provider business mailing address

677 W 375 S
HURRICANE UT
84737-3250
US

V. Phone/Fax

Practice location:
  • Phone: 435-703-0218
  • Fax:
Mailing address:
  • Phone: 435-703-0218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6234926-3501
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number6234926-3902
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: