Healthcare Provider Details

I. General information

NPI: 1285799254
Provider Name (Legal Business Name): TY JUAN MARKHAM PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 W. MAIN ST.
TORREY UT
84775
US

IV. Provider business mailing address

150 N. CENTER ST. P.O. BOX 750337
TORREY UT
84775
US

V. Phone/Fax

Practice location:
  • Phone: 435-491-0230
  • Fax: 801-581-6243
Mailing address:
  • Phone: 435-491-0230
  • Fax: 801-581-6243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number270973-2501
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number270973-2501
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number270973-2501
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number270973-2501
License Number StateUT
# 5
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number270973-2501
License Number StateUT
# 6
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number270973-2501
License Number StateUT
# 7
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number270973-2501
License Number StateUT
# 8
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number270973-2501
License Number StateUT
# 9
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number270973-2501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: