Healthcare Provider Details

I. General information

NPI: 1508233610
Provider Name (Legal Business Name): KELSON CROWTHER M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2015
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2240 ADAMS AVE
OGDEN UT
84401-1511
US

IV. Provider business mailing address

2240 ADAMS AVE
OGDEN UT
84401-1511
US

V. Phone/Fax

Practice location:
  • Phone: 801-393-3535
  • Fax: 801-394-4609
Mailing address:
  • Phone: 801-393-3535
  • Fax: 801-394-4609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number10906779-2501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: