Healthcare Provider Details

I. General information

NPI: 1639513278
Provider Name (Legal Business Name): MR. COURTNEY TAYLOR LYMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2013
Last Update Date: 01/27/2020
Certification Date: 01/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 S STATE ST
LA VERKIN UT
84745-5443
US

IV. Provider business mailing address

50 S STATE ST
LA VERKIN UT
84745-5443
US

V. Phone/Fax

Practice location:
  • Phone: 877-698-4968
  • Fax:
Mailing address:
  • Phone: 877-698-4968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: