MEDICARE: SCPTR WELLNESS L.L.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	2084P0800X	Psychiatry Physician
2	103T00000X	Psychologist
3	103TC1900X	Counseling Psychologist
4	103TC2200X	Clinical Child & Adolescent Psychologist
5	103G00000X	Clinical Neuropsychologist

General Provider Information

NPI Number	:	1184260549
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCPTR WELLNESS L.L.C.

Provider Business Mailing Address
First Line	:	2936 S HIGHLAND DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-3582
Country	:	US
Telephone Number	:	385-259-0376
Fax Number	:

Provider Business Practice Location Address
First Line	:	2936 S HIGHLAND DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-3582
Country	:	US
Telephone Number	:	385-259-0376
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	PARTHA GANDHI
Credential	:	PHD
Telephone Number	:	385-259-0376

Provider Enumeration Date	:	11/20/2019
Last Update Date	:	11/20/2019

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Directions to “SCPTR WELLNESS L.L.C. ” Practice Location

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