Individual
TIVOLI COUSINEAU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMFT
Contact information
Practice address
6640 OLD FOREST DR, PARK CITY, UT 84098-5958
(310) 384-0086
Mailing address
6640 OLD FOREST DR, PARK CITY, UT 84098-5958
(310) 384-0086
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
10511721-3902
UT
106H00000X
Marriage & Family Therapist
83685
CA
Other
Enumeration date
08/11/2015
Last updated
10/07/2025
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