Provider Demographics
NPI:1194902726
Name:UTSCH, ADRIAN B (PSYD)
Entity type:Individual
Prefix:
First Name:ADRIAN
Middle Name:B
Last Name:UTSCH
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 S 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-4468
Mailing Address - Country:US
Mailing Address - Phone:808-344-0435
Mailing Address - Fax:
Practice Address - Street 1:300 N WILLSON AVE STE 3005-6
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-3537
Practice Address - Country:US
Practice Address - Phone:808-344-0435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-25
Last Update Date:2017-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPSY-PSY-LIC-2205103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical