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General NPI Number Information
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NPI Number | 1326217704
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Entity Type | Individual
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Provider Name | TIMANDRA E. FAWSON LMFT
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Gender | Female
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Dates
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Enumeration Date | 02/29/2008
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Last Update Date | 02/29/2008
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Provider Practice Location Address
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Address Line | 173 N 250 W
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City | LA VERKIN
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State | UT
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Zip | 84745-5236
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Country | US
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Telephone | 435-635-7174
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Fax |
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Provider Business Mailing Address
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Address Line | 173 N 250 W
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City | LA VERKIN
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State | UT
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Zip | 84745-5236
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Country | US
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Telephone | 435-635-7174
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Fax |
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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 | 5901026-3902
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License Number State | UT
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