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General NPI Number Information
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NPI Number | 1003982778
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Entity Type | Individual
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Provider Name | TIMOTHY JOHN CREGOR LMFT
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Gender | Male
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Dates
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Enumeration Date | 11/27/2006
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Last Update Date | 11/29/2024
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Provider Practice Location Address
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Address Line | 3355 N. UNIVERSITY AVE., STE. 250
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City | PROVO
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State | UT
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Zip | 84604-6640
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Country | US
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Telephone | 559-789-2503
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Fax | 801-503-9833
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Provider Business Mailing Address
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Address Line | 430 E. DEER RIDGE DR.
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City | MIDWAY
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State | UT
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Zip | 84049-4500
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Country | US
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Telephone | 559-789-2503
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Fax | 801-503-9833
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 46921
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 10438004-3902
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License Number State | UT
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