Healthcare Provider Details

I. General information

NPI: 1366413627
Provider Name (Legal Business Name): JONATHAN DANIEL SHERMAN LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1753 SIDEWINDER DR
PARK CITY UT
84060-7258
US

IV. Provider business mailing address

632 E 230 N
AMERICAN FORK UT
84003-2948
US

V. Phone/Fax

Practice location:
  • Phone: 435-649-8347
  • Fax: 435-649-2157
Mailing address:
  • Phone: 801-492-3415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number3630933902
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: