Provider Demographics
NPI:1467631051
Name:MARYON, DOROTHY KAY (LPC)
Entity Type:Individual
Prefix:MRS
First Name:DOROTHY
Middle Name:KAY
Last Name:MARYON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15106 EAGLE CHASE DR
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-5712
Mailing Address - Country:US
Mailing Address - Phone:801-619-4619
Mailing Address - Fax:
Practice Address - Street 1:151 E 5600 S STE 204
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-8146
Practice Address - Country:US
Practice Address - Phone:801-380-5086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5691745-6004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional