Provider Demographics
NPI:1356742829
Name:MAZZAGLIA, TONI MARIE (ACMHC)
Entity type:Individual
Prefix:MS
First Name:TONI
Middle Name:MARIE
Last Name:MAZZAGLIA
Suffix:
Gender:F
Credentials:ACMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10209 S DIMPLE DELL RD
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84092-4536
Mailing Address - Country:US
Mailing Address - Phone:801-838-8991
Mailing Address - Fax:801-838-8920
Practice Address - Street 1:10209 S DIMPLE DELL RD
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84092-4536
Practice Address - Country:US
Practice Address - Phone:801-838-8991
Practice Address - Fax:801-838-8920
Is Sole Proprietor?:No
Enumeration Date:2014-09-15
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9047422-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health