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General NPI Number Information
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NPI Number | 1912274473
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Entity Type | Individual
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Provider Name | TAUHEEDAH SABREEN WALLACE MSSW-MFT, LAMFT
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Gender | Female
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Dates
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Enumeration Date | 11/28/2011
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Last Update Date | 11/28/2011
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Provider Practice Location Address
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Address Line | 750 N FREEDOM BLVD STE 300
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City | PROVO
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State | UT
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Zip | 84601-1690
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Country | US
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Telephone | 801-377-1213
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Fax |
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Provider Business Mailing Address
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Address Line | 537 E 650 S
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City | OREM
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State | UT
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Zip | 84097-6336
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Country | US
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Telephone | 404-422-5282
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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 | 7921461-3904
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License Number State | UT
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