1578643771 NPI number — DAVID NEWBOLD PHD & ASSOCIATES, LLC

Table of content: (NPI 1578643771)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578643771 NPI number — DAVID NEWBOLD PHD & ASSOCIATES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVID NEWBOLD PHD & ASSOCIATES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DAVID NEWBOLD, PHD
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578643771
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 212
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KAYSVILLE
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84037-0212
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-776-1954
Provider Business Mailing Address Fax Number:
801-774-9602

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
370 S 500 E
Provider Second Line Business Practice Location Address:
SUITE 180
Provider Business Practice Location Address City Name:
CLEARFIELD
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84015-4057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-776-1954
Provider Business Practice Location Address Fax Number:
801-774-9602
Provider Enumeration Date:
10/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NEWBOLD
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
LICENSED PSYCHOLOGIST/OWNER
Authorized Official Telephone Number:
801-776-1954

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  841122042501 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 529780736017 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".




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