Provider Demographics
NPI:1316376270
Name:MARVIN, LUKE
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:
Last Name:MARVIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 S 100 E STE 300
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:UT
Mailing Address - Zip Code:84651-2253
Mailing Address - Country:US
Mailing Address - Phone:801-382-9338
Mailing Address - Fax:801-383-0246
Practice Address - Street 1:95 S 100 E STE 300
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-2253
Practice Address - Country:US
Practice Address - Phone:801-382-9338
Practice Address - Fax:801-383-0246
Is Sole Proprietor?:No
Enumeration Date:2013-11-01
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10036165-2501103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist