Provider Demographics
NPI:1417249921
Name:ALONZO, ANTHONY T (MS, LMFT, CFLE)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:T
Last Name:ALONZO
Suffix:
Gender:M
Credentials:MS, LMFT, CFLE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10138 S 460 W STE 2
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-3900
Mailing Address - Country:US
Mailing Address - Phone:801-285-8955
Mailing Address - Fax:801-972-0390
Practice Address - Street 1:10138 S 460 W STE 2
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-3900
Practice Address - Country:US
Practice Address - Phone:801-285-8955
Practice Address - Fax:801-972-0390
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-03
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6702499-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist