1518157882 NPI number — MS. ANDREA SHIELDS PH.D., LMFT

Table of content: MS. ANDREA SHIELDS PH.D., LMFT (NPI 1518157882)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518157882 NPI number — MS. ANDREA SHIELDS PH.D., LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHIELDS
Provider First Name:
ANDREA
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PH.D., LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518157882
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4516 S 700 E STE 180
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MURRAY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84107-8320
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-824-2862
Provider Business Mailing Address Fax Number:
801-590-8717

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4516 S 700 E STE 180
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MURRAY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84107-8320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-824-2862
Provider Business Practice Location Address Fax Number:
801-590-8717
Provider Enumeration Date:
08/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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