Provider Demographics
NPI:1568010320
Name:TAMASHIRO, MARTIE (ACMHC)
Entity Type:Individual
Prefix:
First Name:MARTIE
Middle Name:
Last Name:TAMASHIRO
Suffix:
Gender:F
Credentials:ACMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2817 W SHADY HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-5715
Mailing Address - Country:US
Mailing Address - Phone:801-597-7056
Mailing Address - Fax:
Practice Address - Street 1:145 S 200 E
Practice Address - Street 2:
Practice Address - City:LINDON
Practice Address - State:UT
Practice Address - Zip Code:84042-2047
Practice Address - Country:US
Practice Address - Phone:801-784-9455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5836003-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty