Healthcare Provider Details

I. General information

NPI: 1720512270
Provider Name (Legal Business Name): ALLRED PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2017
Last Update Date: 12/13/2022
Certification Date: 12/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 W CENTER ST
OREM UT
84057-5207
US

IV. Provider business mailing address

2312 W 490 S
PROVO UT
84601-5619
US

V. Phone/Fax

Practice location:
  • Phone: 801-903-5903
  • Fax:
Mailing address:
  • Phone: 801-472-4251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number8418220-2501
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. AARON ALLRED
Title or Position: OWNER AND CLINICAL PYCHOLOGIST
Credential: PH.D.
Phone: 801-472-4251