Provider Demographics
NPI:1285799254
Name:MARKHAM, TY JUAN (PSYD)
Entity type:Individual
Prefix:DR
First Name:TY
Middle Name:JUAN
Last Name:MARKHAM
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 N. CENTER ST.
Mailing Address - Street 2:P.O. BOX 750337
Mailing Address - City:TORREY
Mailing Address - State:UT
Mailing Address - Zip Code:84775
Mailing Address - Country:US
Mailing Address - Phone:435-491-0230
Mailing Address - Fax:801-581-6243
Practice Address - Street 1:87 W. MAIN ST.
Practice Address - Street 2:
Practice Address - City:TORREY
Practice Address - State:UT
Practice Address - Zip Code:84775
Practice Address - Country:US
Practice Address - Phone:435-491-0230
Practice Address - Fax:801-581-6243
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT270973-2501103G00000X, 103TA0700X, 103TB0200X, 103TC0700X, 103TC1900X, 103TF0000X, 103T00000X, 103TP2701X, 103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Not Answered103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Not Answered103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation