Healthcare Provider Details

I. General information

NPI: 1659885317
Provider Name (Legal Business Name): MARYNELL LORNA LUNDQUIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2017
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

162 N 400 E STE A105
ST GEORGE UT
84770-7192
US

IV. Provider business mailing address

162 N 400 E STE A105
ST GEORGE UT
84770-7192
US

V. Phone/Fax

Practice location:
  • Phone: 435-275-8911
  • Fax: 435-200-9442
Mailing address:
  • Phone: 435-275-8911
  • Fax: 435-200-9442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12371718-6004
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: