Provider Demographics
NPI:1467011486
Name:LAWS, ROMAN
Entity Type:Individual
Prefix:
First Name:ROMAN
Middle Name:
Last Name:LAWS
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:PO BOX 174
Mailing Address - Street 2:
Mailing Address - City:CEDAR VALLEY
Mailing Address - State:UT
Mailing Address - Zip Code:84013-0174
Mailing Address - Country:US
Mailing Address - Phone:385-351-5473
Mailing Address - Fax:
Practice Address - Street 1:8176 N OCONNELL LN
Practice Address - Street 2:
Practice Address - City:EAGLE MOUNTAIN
Practice Address - State:UT
Practice Address - Zip Code:84005-5813
Practice Address - Country:US
Practice Address - Phone:385-351-5473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCP5586-R101YM0800X
ORC7878101YM0800X
IDLCPC-10067101YM0800X
WALH61492131101YM0800X
UT12310252-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT12310252-6004OtherCMHC LICENSE