Healthcare Provider Details

I. General information

NPI: 1417867995
Provider Name (Legal Business Name): TANRA THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1282 N GENEVA RD
PROVO UT
84601-1284
US

IV. Provider business mailing address

1282 N GENEVA RD
PROVO UT
84601-1284
US

V. Phone/Fax

Practice location:
  • Phone: 801-919-6858
  • Fax:
Mailing address:
  • Phone: 801-919-6858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: TANRA HILL
Title or Position: THERAPIST
Credential: LCSW
Phone: 801-919-6858