Healthcare Provider Details

I. General information

NPI: 1831940238
Provider Name (Legal Business Name): AMANDA E SEVERSON LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2024
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 S MAIN ST
SPANISH FORK UT
84660-5738
US

IV. Provider business mailing address

675 N 190 E
VINEYARD UT
84059-6524
US

V. Phone/Fax

Practice location:
  • Phone: 801-990-4304
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: