Healthcare Provider Details

I. General information

NPI: 1427105493
Provider Name (Legal Business Name): JOHN D. PEROVICH PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2007
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 Number3454712501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: