Provider Demographics
NPI:1003982778
Name:CREGOR, TIMOTHY JOHN (LMFT)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:JOHN
Last Name:CREGOR
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 E. DEER RIDGE DR.
Mailing Address - Street 2:
Mailing Address - City:MIDWAY
Mailing Address - State:UT
Mailing Address - Zip Code:84049-4500
Mailing Address - Country:US
Mailing Address - Phone:559-789-2503
Mailing Address - Fax:801-503-9833
Practice Address - Street 1:3355 N. UNIVERSITY AVE., STE. 250
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-6640
Practice Address - Country:US
Practice Address - Phone:559-789-2503
Practice Address - Fax:801-503-9833
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2024-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46921106H00000X
UT10438004-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6353OtherCOUNTY ISSUED NUMBER