Provider Demographics
NPI:1255120093
Name:LOVELL, TYSON WILLIAM (LAMFT)
Entity type:Individual
Prefix:
First Name:TYSON
Middle Name:WILLIAM
Last Name:LOVELL
Suffix:
Gender:
Credentials:LAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1492 N 565 W APT 102
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-6770
Mailing Address - Country:US
Mailing Address - Phone:360-964-0050
Mailing Address - Fax:
Practice Address - Street 1:2150 N MAIN ST STE 9
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-1740
Practice Address - Country:US
Practice Address - Phone:435-932-0211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13786718-3904101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health