Healthcare Provider Details

I. General information

NPI: 1750346250
Provider Name (Legal Business Name): DANIEL WOODBURY LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 07/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1317 E 750 N
OREM UT
84097-5480
US

IV. Provider business mailing address

PO BOX 340
OREM UT
84059-0340
US

V. Phone/Fax

Practice location:
  • Phone: 801-852-1141
  • Fax: 801-223-7130
Mailing address:
  • Phone: 801-852-1141
  • Fax: 801-223-7130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number5889510-3904
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number5889510-3902
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: