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NPI Code Detail

MEDICARE: MISTALYN JOY DEMANN LAMFT

MEDICARE: MISTALYN JOY DEMANN LAMFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist117513533904UT

General Provider Information

NPI Number : 1306361399
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISTALYN JOY DEMANN LAMFT
Provider Business Mailing Address
First Line : 9035 S 1300 E STE 120
Second Line :
City : SANDY
State : UT
Zip : 84094-3192
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4505 S WASATCH BLVD STE 290
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84124-4204
Country : US
Telephone Number : 385-695-5949
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2017
Last Update Date : 09/02/2021

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