Provider Demographics
NPI:1841507308
Name:WASATCH PSYCHOLOGICAL CONSULTANTS
Entity type:Organization
Organization Name:WASATCH PSYCHOLOGICAL CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:435-647-2911
Mailing Address - Street 1:136 HEBER AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84060-5131
Mailing Address - Country:US
Mailing Address - Phone:435-647-2911
Mailing Address - Fax:
Practice Address - Street 1:136 HEBER AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84060-5131
Practice Address - Country:US
Practice Address - Phone:435-647-2911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-06
Last Update Date:2010-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT114801-2501261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health