Healthcare Provider Details

I. General information

NPI: 1477157345
Provider Name (Legal Business Name): ARMEN GUSHCHYAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2020
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6405 OLD MAIN HILL
LOGAN UT
84322-6405
US

IV. Provider business mailing address

6405 OLD MAIN HILL
LOGAN UT
84322-6405
US

V. Phone/Fax

Practice location:
  • Phone: 435-797-4200
  • Fax: 844-308-5865
Mailing address:
  • Phone: 435-797-6405
  • Fax: 844-308-5865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number13928930-2506
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: