Provider Demographics
NPI:1710088166
Name:MARSHALL, EUGENE INIA TAMIHANA (LCSW)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:INIA TAMIHANA
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:439 E 2000 S
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84058-8149
Mailing Address - Country:US
Mailing Address - Phone:801-921-9244
Mailing Address - Fax:
Practice Address - Street 1:5600 NORTH HERITAGE DRIVE
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-1677
Practice Address - Country:US
Practice Address - Phone:801-226-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT357889-3502104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker