Provider Demographics
NPI:1730782038
Name:SPENDLOVE, TINA
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:SPENDLOVE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3823 S OLD HIGHWAY 91
Mailing Address - Street 2:
Mailing Address - City:NEW HARMONY
Mailing Address - State:UT
Mailing Address - Zip Code:84757-5179
Mailing Address - Country:US
Mailing Address - Phone:435-225-4117
Mailing Address - Fax:
Practice Address - Street 1:1460 S PROVIDENCE CENTER DR STE 2
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720-1981
Practice Address - Country:US
Practice Address - Phone:435-586-4479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health