Provider Demographics
NPI:1013051077
Name:DANIELSON, TRICIA HILL (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:HILL
Last Name:DANIELSON
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 E 2200 N
Mailing Address - Street 2:C-103
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341
Mailing Address - Country:US
Mailing Address - Phone:208-339-2847
Mailing Address - Fax:435-752-1095
Practice Address - Street 1:270 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-3915
Practice Address - Country:US
Practice Address - Phone:208-339-2847
Practice Address - Fax:435-752-1095
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5410811-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist