Provider Demographics
NPI:1184368748
Name:BROUGH, TINA N (MFT-I)
Entity type:Individual
Prefix:MRS
First Name:TINA
Middle Name:N
Last Name:BROUGH
Suffix:
Gender:F
Credentials:MFT-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2608 W 175 N
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:UT
Mailing Address - Zip Code:84737-4431
Mailing Address - Country:US
Mailing Address - Phone:801-404-1400
Mailing Address - Fax:
Practice Address - Street 1:1173 S 250 W STE 208
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-6747
Practice Address - Country:US
Practice Address - Phone:435-688-1111
Practice Address - Fax:435-688-8488
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-20
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT13438849-3902OtherDOPL