Provider Demographics
NPI:1972755395
Name:SNELL, ALISA GOODWIN (LMFT)
Entity Type:Individual
Prefix:
First Name:ALISA
Middle Name:GOODWIN
Last Name:SNELL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1361 N. HWY 89
Mailing Address - Street 2:UNIT 11
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025
Mailing Address - Country:US
Mailing Address - Phone:801-447-6000
Mailing Address - Fax:801-479-9684
Practice Address - Street 1:1361 N HIGHWAY 89 UNIT 11
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025-2750
Practice Address - Country:US
Practice Address - Phone:801-447-6000
Practice Address - Fax:801-479-9684
Is Sole Proprietor?:No
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT316416-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist