Provider Demographics
NPI:1891820114
Name:SANGREE, JOAN S (MFT)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:S
Last Name:SANGREE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 E CENTER ST
Mailing Address - Street 2:SUITE #3
Mailing Address - City:MOAB
Mailing Address - State:UT
Mailing Address - Zip Code:84532-2473
Mailing Address - Country:US
Mailing Address - Phone:435-259-4113
Mailing Address - Fax:435-259-5542
Practice Address - Street 1:50 E CENTER ST
Practice Address - Street 2:SUITE #3
Practice Address - City:MOAB
Practice Address - State:UT
Practice Address - Zip Code:84532-2473
Practice Address - Country:US
Practice Address - Phone:435-259-4113
Practice Address - Fax:435-259-5542
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT264466-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT52888OtherPEHP
UT02001OtherBLUE CROSS BLUE SHIELD