Provider Demographics
NPI:1255757100
Name:PARKS, AMY ANDRUS (MS LMFT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:ANDRUS
Last Name:PARKS
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 1:199 N 290 W STE 150
Mailing Address - Street 2:
Mailing Address - City:LINDON
Mailing Address - State:UT
Mailing Address - Zip Code:84042-5004
Mailing Address - Country:US
Mailing Address - Phone:801-406-8994
Mailing Address - Fax:
Practice Address - Street 1:199 N 290 W STE 150
Practice Address - Street 2:
Practice Address - City:LINDON
Practice Address - State:UT
Practice Address - Zip Code:84042-5004
Practice Address - Country:US
Practice Address - Phone:801-406-8994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-14
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT370409-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist