MEDICARE: SARI ANN SOUTOR FARHART PH.D.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC2200X	Clinical Child & Adolescent Psychologist	60525992501	UT

General Provider Information

NPI Number	:	1861402026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARI ANN SOUTOR FARHART PH.D.

Provider Business Mailing Address
First Line	:	4335 S 2700 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-3720
Country	:	US
Telephone Number	:	801-910-6191
Fax Number	:	435-487-9107

Provider Business Practice Location Address
First Line	:	2760 RASMUSSEN RD
Second Line	:	STE 205
City	:	PARK CITY
State	:	UT
Zip	:	84098-5684
Country	:	US
Telephone Number	:	435-645-9240
Fax Number	:	435-487-9687

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	07/29/2011

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