Provider Demographics
NPI:1578739215
Name:TOOHILL, MARTIN J (PHD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:J
Last Name:TOOHILL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6813 OLD MAIN HL
Mailing Address - Street 2:CENTER FOR PERSONS WITH DISABILITIES
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84322-6813
Mailing Address - Country:US
Mailing Address - Phone:435-797-3822
Mailing Address - Fax:435-797-3944
Practice Address - Street 1:6813 OLD MAIN HL
Practice Address - Street 2:CENTER FOR PERSONS WITH DISABILITIES
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84322-6813
Practice Address - Country:US
Practice Address - Phone:435-797-3822
Practice Address - Fax:435-797-3944
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-02
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6041554-2501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical