Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 270973-2501 | UT |
N | 103TC0700X | Clinical Psychologist | 270973-2501 | UT |
N | 102L00000X | Psychologist | 270973-2501 | UT |
N | 103T00000X | Psychologist | 270973-2501 | UT |
N | 103TA0700X | Adult Development & Aging Psychologist | 270973-2501 | UT |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 270973-2501 | UT |
N | 103G00000X | Clinical Psychologist | 270973-2501 | UT |
N | 103TC0700X | Clinical Psychologist | 270973-2501 | UT |
N | 103TC1900X | Counseling Psychologist | 270973-2501 | UT |
N | 103TF0000X | Family Psychologist | 270973-2501 | UT |
N | 103TP2701X | Group Psychotherapist | 270973-2501 | UT |
N | 103TR0400X | Rehabilitation Psychologist | 270973-2501 | UT |
NPI | 1285799254 |
---|---|
Provider Name | Dr. Ty Juan Markham |
First Address | Torrey, UT 84775 |
Second Address | Torrey, UT 84775 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2006 |
Last Update Date | 08/07/2007 |