Provider Demographics
NPI:1992258644
Name:PRIESTLEY, TAMRA JG (ACMHC)
Entity type:Individual
Prefix:
First Name:TAMRA
Middle Name:JG
Last Name:PRIESTLEY
Suffix:
Gender:F
Credentials:ACMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 W 100 S STE 386
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-5838
Mailing Address - Country:US
Mailing Address - Phone:435-915-6915
Mailing Address - Fax:435-226-4484
Practice Address - Street 1:95 W 100 S STE 386
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-5838
Practice Address - Country:US
Practice Address - Phone:435-915-6915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-29
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9763782-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health