Healthcare Provider Details

I. General information

NPI: 1336731348
Provider Name (Legal Business Name): LAURIE ALLPHIN LOVELAND MED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2021
Last Update Date: 02/10/2021
Certification Date: 02/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1258 W SOUTH JORDAN PKWY
SOUTH JORDAN UT
84095-4711
US

IV. Provider business mailing address

746 HIGH RIDGE CIR
ALPINE UT
84004-2629
US

V. Phone/Fax

Practice location:
  • Phone: 801-255-1155
  • Fax:
Mailing address:
  • Phone: 801-492-9079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number200329-6009
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: