=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548126816
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FATKIN FAMILY COUNSELING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/31/2025
-----------------------------------------------------
Last Update Date | 12/31/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 321 N MALL DR STE 103
-----------------------------------------------------
City | ST GEORGE
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84790-7302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 435-216-0699
-----------------------------------------------------
Fax | 435-359-5270
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1141 W 250 N
-----------------------------------------------------
City | HURRICANE
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84737-3426
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 435-216-0699
-----------------------------------------------------
Fax | 435-359-5270
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KENNETH FATKIN
-----------------------------------------------------
Credential | LMFT
-----------------------------------------------------
Telephone | 435-216-0699
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------