Provider Demographics
NPI:1326217704
Name:FAWSON, TIMANDRA E (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:TIMANDRA
Middle Name:E
Last Name:FAWSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 N 250 W
Mailing Address - Street 2:
Mailing Address - City:LA VERKIN
Mailing Address - State:UT
Mailing Address - Zip Code:84745-5236
Mailing Address - Country:US
Mailing Address - Phone:435-635-7174
Mailing Address - Fax:
Practice Address - Street 1:173 N 250 W
Practice Address - Street 2:
Practice Address - City:LA VERKIN
Practice Address - State:UT
Practice Address - Zip Code:84745-5236
Practice Address - Country:US
Practice Address - Phone:435-635-7174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-29
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5901026-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist