Provider Demographics
NPI:1457787731
Name:THAYNE, TAMI L (CSW)
Entity Type:Individual
Prefix:MRS
First Name:TAMI
Middle Name:L
Last Name:THAYNE
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1864 N 400 E
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84097-2241
Mailing Address - Country:US
Mailing Address - Phone:801-362-8119
Mailing Address - Fax:
Practice Address - Street 1:1864 N 400 E
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84097-2241
Practice Address - Country:US
Practice Address - Phone:801-362-8119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-18
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7981078-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical