Basic Information
| Provider Information | |||||||||
| NPI: | 1568015287 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOMAS | ||||||||
| FirstName: | MARION | ||||||||
| MiddleName: | LEIALOHALANI | ||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1140 WEST 1130 S BUILDING B | ||||||||
| Address2: | |||||||||
| City: | OREM | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840658288 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8019354171 | ||||||||
| FaxNumber: | 8019354946 | ||||||||
| Practice Location | |||||||||
| Address1: | 1140 WEST 1130 SOUTH BUILDING B | ||||||||
| Address2: | |||||||||
| City: | OREM | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840582888 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8016685229 | ||||||||
| FaxNumber: | 8019354946 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2019 | ||||||||
| LastUpdateDate: | 07/22/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.