Provider Demographics
NPI:1801551577
Name:HARMON, TJ MICHAEL (CMHC)
Entity type:Individual
Prefix:MR
First Name:TJ
Middle Name:MICHAEL
Last Name:HARMON
Suffix:
Gender:M
Credentials:CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9140 S STATE ST STE 201
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-2694
Mailing Address - Country:US
Mailing Address - Phone:385-455-3768
Mailing Address - Fax:
Practice Address - Street 1:9140 S STATE ST STE 201
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-2694
Practice Address - Country:US
Practice Address - Phone:385-455-3768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-07
Last Update Date:2021-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1065491-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTNAMedicaid