Healthcare Provider Details

I. General information

NPI: 1184368748
Provider Name (Legal Business Name): TINA N BROUGH MFT-I
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2022
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1173 S 250 W STE 208
ST GEORGE UT
84770-6747
US

IV. Provider business mailing address

2608 W 175 N
HURRICANE UT
84737-4431
US

V. Phone/Fax

Practice location:
  • Phone: 435-688-1111
  • Fax: 435-688-8488
Mailing address:
  • Phone: 801-404-1400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: