Provider Demographics
NPI:1861608416
Name:FADDIS, TROY JONATHAN (LMFT)
Entity type:Individual
Prefix:MR
First Name:TROY
Middle Name:JONATHAN
Last Name:FADDIS
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 1:72 W PATRIOT WAY UNIT 1139
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84701-1888
Mailing Address - Country:US
Mailing Address - Phone:435-200-3422
Mailing Address - Fax:435-836-2274
Practice Address - Street 1:72 W PATRIOT WAY UNIT 1139
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:UT
Practice Address - Zip Code:84701-1888
Practice Address - Country:US
Practice Address - Phone:435-200-3422
Practice Address - Fax:435-836-2274
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT49897413902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist