Provider Demographics
NPI:1154342731
Name:THIBAULT, NORMAN EDWARD (PHD, LMFT)
Entity type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:EDWARD
Last Name:THIBAULT
Suffix:
Gender:M
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 E 2700 S
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:UT
Mailing Address - Zip Code:84737-4000
Mailing Address - Country:US
Mailing Address - Phone:435-635-0636
Mailing Address - Fax:435-304-0004
Practice Address - Street 1:1500 E 2700 S
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:UT
Practice Address - Zip Code:84737
Practice Address - Country:US
Practice Address - Phone:435-635-0636
Practice Address - Fax:435-304-0004
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT367367-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty