Organization
UNCONVENTIONAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARTIE TAMASHIRO MA, CMHC (OWNER)
(801) 857-0102
Entity
Organization
Contact information
Practice address
2901 W BLUE GRASS BLVD STE 200, LEHI, UT 84043-4190
(435) 557-4355
Mailing address
2901 W BLUE GRASS BLVD STE 200, LEHI, UT 84043-4190
(435) 557-4355
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
01/14/2022
Last updated
01/14/2022
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