Provider Demographics
NPI:1942951587
Name:TAMASHIRO, LANCE (MS, ACMHC)
Entity Type:Individual
Prefix:
First Name:LANCE
Middle Name:
Last Name:TAMASHIRO
Suffix:
Gender:M
Credentials:MS, ACMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 W BLUE GRASS BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-4190
Mailing Address - Country:US
Mailing Address - Phone:801-857-0102
Mailing Address - Fax:
Practice Address - Street 1:2901 W BLUE GRASS BLVD STE 200
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-4190
Practice Address - Country:US
Practice Address - Phone:801-857-0102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-14
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12617017-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health