1952710071 NPI number — THE PEARCE INSTITUTE OF CHILD AND FAMILY PSYCHOLOGY, LLC

Table of content: (NPI 1952710071)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952710071 NPI number — THE PEARCE INSTITUTE OF CHILD AND FAMILY PSYCHOLOGY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE PEARCE INSTITUTE OF CHILD AND FAMILY PSYCHOLOGY, 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:
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:
1952710071
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/04/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
231 E 2100 S
Provider Second Line Business Mailing Address:
SUITE 203
Provider Business Mailing Address City Name:
SALT LAKE CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84115-2187
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-901-4311
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
231 E 2100 S
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
SALT LAKE CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84115-2187
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-901-4311
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/04/2014

Additional Information

Authorized Official

Authorized Official Last Name:
PEARCE
Authorized Official First Name:
BRETT
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
CLINICAL DIRECTOR
Authorized Official Telephone Number:
801-901-4311

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  8546756-2501 , 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)

  • Identifier: 8546756-2501 . This is a "LICENSE" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".




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