Provider Demographics
NPI:1639513278
Name:LYMAN, COURTNEY TAYLOR
Entity type:Individual
Prefix:MR
First Name:COURTNEY
Middle Name:TAYLOR
Last Name:LYMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:LA VERKIN
Mailing Address - State:UT
Mailing Address - Zip Code:84745-5443
Mailing Address - Country:US
Mailing Address - Phone:877-698-4968
Mailing Address - Fax:
Practice Address - Street 1:50 S STATE ST
Practice Address - Street 2:
Practice Address - City:LA VERKIN
Practice Address - State:UT
Practice Address - Zip Code:84745-5443
Practice Address - Country:US
Practice Address - Phone:877-698-4968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-25
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1114457843Medicaid