Healthcare Provider Details

I. General information

NPI: 1942451869
Provider Name (Legal Business Name): THERESA D. MASSEY LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2008
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 N 300 W STE 2
ST GEORGE UT
84770-2770
US

IV. Provider business mailing address

1194 TAMARISK DR
ST GEORGE UT
84790-6933
US

V. Phone/Fax

Practice location:
  • Phone: 562-533-8257
  • Fax: 435-429-6717
Mailing address:
  • Phone: 562-533-8257
  • Fax: 435-429-6717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number13816115-3902
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number13816115-3902
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: