Healthcare Provider Details

I. General information

NPI: 1720813066
Provider Name (Legal Business Name): MADELINE NICOLE EVANS TOBARI MMFT, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MADELINE EVANS MMFT, LMFT

II. Dates (important events)

Enumeration Date: 09/05/2024
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8180 S 700 E STE 230-4
SANDY UT
84070-0562
US

IV. Provider business mailing address

10561 E SPRING CREEK DR
HEBER CITY UT
84032-4982
US

V. Phone/Fax

Practice location:
  • Phone: 801-224-2313
  • Fax:
Mailing address:
  • Phone: 435-200-5833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number13996452-3902
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: