Healthcare Provider Details

I. General information

NPI: 1265811368
Provider Name (Legal Business Name): JOANNA SUMSION AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2015
Last Update Date: 07/22/2020
Certification Date: 07/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4626 N 300 W
PROVO UT
84604-7763
US

IV. Provider business mailing address

4626 N 300 W STE 150
PROVO UT
84604-6077
US

V. Phone/Fax

Practice location:
  • Phone: 801-407-4134
  • Fax:
Mailing address:
  • Phone: 801-407-4134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number11107743-3904
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: