Provider Demographics
NPI:1053864066
Name:GHANE, TAKAVAR (LCMHC)
Entity Type:Individual
Prefix:MR
First Name:TAKAVAR
Middle Name:
Last Name:GHANE
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1664 S DIXIE DR STE E102
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-7329
Mailing Address - Country:US
Mailing Address - Phone:435-703-9647
Mailing Address - Fax:435-703-6003
Practice Address - Street 1:1664 S DIXIE DR STE E102
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-7329
Practice Address - Country:US
Practice Address - Phone:435-703-9647
Practice Address - Fax:435-703-6003
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-26
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6782719-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health