Provider Demographics
NPI:1093494304
Name:CONNOR BARHAM, LMFT, PLLC
Entity Type:Organization
Organization Name:CONNOR BARHAM, LMFT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CONNOR
Authorized Official - Middle Name:
Authorized Official - Last Name:BARHAM
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:801-899-3988
Mailing Address - Street 1:270 N 1080 E
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84606-3518
Mailing Address - Country:US
Mailing Address - Phone:801-708-9988
Mailing Address - Fax:
Practice Address - Street 1:3325 N UNIVERSITY AVE STE 275
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-7415
Practice Address - Country:US
Practice Address - Phone:801-899-3988
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty