Provider Demographics
NPI:1598374134
Name:TROY FADDIS, LMFT - PLLC
Entity Type:Organization
Organization Name:TROY FADDIS, LMFT - PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:JONATHAN
Authorized Official - Last Name:FADDIS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:801-609-8462
Mailing Address - Street 1:72 W PATRIOT WAY UNIT 1139
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84701-1888
Mailing Address - Country:US
Mailing Address - Phone:801-609-8462
Mailing Address - Fax:
Practice Address - Street 1:72 W PATRIOT WAY UNIT 1139
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:UT
Practice Address - Zip Code:84701-1888
Practice Address - Country:US
Practice Address - Phone:801-609-8462
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty