Provider Demographics
NPI:1609006246
Name:LEIFSON, TAMARA M (LCSW)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:M
Last Name:LEIFSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 OAKRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-8402
Mailing Address - Country:US
Mailing Address - Phone:801-592-1729
Mailing Address - Fax:
Practice Address - Street 1:2520 OAKRIDGE DR
Practice Address - Street 2:
Practice Address - City:SPANISH FORK
Practice Address - State:UT
Practice Address - Zip Code:84660-8402
Practice Address - Country:US
Practice Address - Phone:801-592-1729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-16
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5694429-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical