Healthcare Provider Details

I. General information

NPI: 1407156011
Provider Name (Legal Business Name): LOIS EVELYN SKON LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: L EVELYN SKON LMFT

II. Dates (important events)

Enumeration Date: 10/28/2010
Last Update Date: 04/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 S 600 E SUITE 5
SALT LAKE CITY UT
84102-1017
US

IV. Provider business mailing address

24 S 600 E SUITE 5
SALT LAKE CITY UT
84102-1017
US

V. Phone/Fax

Practice location:
  • Phone: 801-971-4062
  • Fax:
Mailing address:
  • Phone: 801-971-4062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number7509057-3902
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: