Healthcare Provider Details

I. General information

NPI: 1417506270
Provider Name (Legal Business Name): OGDEN PSYCHOLOGICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2019
Last Update Date: 05/16/2022
Certification Date: 05/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1186 E 4600 S STE 110
OGDEN UT
84403-4896
US

IV. Provider business mailing address

1186 E 4600 S STE 110
OGDEN UT
84403-4896
US

V. Phone/Fax

Practice location:
  • Phone: 801-505-6545
  • Fax: 801-505-6545
Mailing address:
  • Phone: 801-505-6545
  • Fax: 801-505-6545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. BRIAN PETROVICH
Title or Position: CLINICAL DIRECTOR
Credential: PSYD
Phone: 801-505-6545