Healthcare Provider Details

I. General information

NPI: 1265846976
Provider Name (Legal Business Name): JOHN D. PEROVICH, PSYD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2014
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1148 W LEGACY CROSSING BLVD STE 130
CENTERVILLE UT
84014-5537
US

IV. Provider business mailing address

1148 W LEGACY CROSSING BLVD STE 130
CENTERVILLE UT
84014-5537
US

V. Phone/Fax

Practice location:
  • Phone: 801-773-0535
  • Fax: 801-773-0536
Mailing address:
  • Phone: 801-773-0535
  • Fax: 801-773-0536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: BRIDGETTE OSTLER-BORING
Title or Position: BILLING MANAGER
Credential:
Phone: 801-773-0535