Provider Demographics
NPI:1427627389
Name:FALEVAI, ATU TONGA MAILE (CSW)
Entity type:Individual
Prefix:
First Name:ATU
Middle Name:TONGA MAILE
Last Name:FALEVAI
Suffix:
Gender:M
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:984 S 930 W
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:UT
Mailing Address - Zip Code:84651-3126
Mailing Address - Country:US
Mailing Address - Phone:801-465-5111
Mailing Address - Fax:
Practice Address - Street 1:1601 E 13200 S
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-9078
Practice Address - Country:US
Practice Address - Phone:801-465-5111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT122012363502101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)