Healthcare Provider Details

I. General information

NPI: 1336567650
Provider Name (Legal Business Name): DWAYNE HORTON LAMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2014
Last Update Date: 04/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 W 1500 N
NEPHI UT
84648-8900
US

IV. Provider business mailing address

257 W 500 S
OREM UT
84058-6197
US

V. Phone/Fax

Practice location:
  • Phone: 435-623-3200
  • Fax:
Mailing address:
  • Phone: 801-602-9342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number8538619-3904
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: