Provider Demographics
NPI:1588475594
Name:MARINO, SYDNEY (LMFT)
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:
Last Name:MARINO
Suffix:
Gender:
Credentials:LMFT
Other - Prefix:
Other - First Name:SYDNEY
Other - Middle Name:
Other - Last Name:TANKENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3725 W 4100 S STE 201
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84120-6490
Mailing Address - Country:US
Mailing Address - Phone:805-390-0754
Mailing Address - Fax:
Practice Address - Street 1:12427 S PASTURE RD
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84096
Practice Address - Country:US
Practice Address - Phone:888-949-4864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-17
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12839320-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist