Provider Demographics
NPI:1306119441
Name:ADVANCED PSYCHOLOGICAL SERVICES
Entity type:Organization
Organization Name:ADVANCED PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHECKETTS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:801-520-4917
Mailing Address - Street 1:180 ALBION VILLAGE WAY
Mailing Address - Street 2:#303
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-5601
Mailing Address - Country:US
Mailing Address - Phone:801-838-7606
Mailing Address - Fax:801-838-7607
Practice Address - Street 1:9140 S STATE ST
Practice Address - Street 2:101B
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-2684
Practice Address - Country:US
Practice Address - Phone:801-838-7606
Practice Address - Fax:801-838-7607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5080319-2501103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty