1306119441 NPI number — ADVANCED PSYCHOLOGICAL SERVICES

Table of content: (NPI 1306119441)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306119441 NPI number — ADVANCED PSYCHOLOGICAL SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED PSYCHOLOGICAL SERVICES
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:
Provider Other Organization Name Type Code:
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:
1306119441
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
180 ALBION VILLAGE WAY
Provider Second Line Business Mailing Address:
#303
Provider Business Mailing Address City Name:
SANDY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84070-5601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-838-7606
Provider Business Mailing Address Fax Number:
801-838-7607

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9140 S STATE ST
Provider Second Line Business Practice Location Address:
101B
Provider Business Practice Location Address City Name:
SANDY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84070-2684
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-838-7606
Provider Business Practice Location Address Fax Number:
801-838-7607
Provider Enumeration Date:
02/21/2012

Additional Information

Authorized Official

Authorized Official Last Name:
CHECKETTS
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
Authorized Official Title or Position:
LICENSED PSYCHOLOGIST
Authorized Official Telephone Number:
801-520-4917

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  5080319-2501 , 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)





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