Healthcare Provider Details

I. General information

NPI: 1275523730
Provider Name (Legal Business Name): MICHAEL JAMES LIND PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1545 E 3300 S
SALT LAKE CITY UT
84106-3370
US

IV. Provider business mailing address

2100 BENGAL BLVD APT. K303
SALT LAKE CITY UT
84121-7135
US

V. Phone/Fax

Practice location:
  • Phone: 801-478-2780
  • Fax: 801-478-2781
Mailing address:
  • Phone: 801-943-3409
  • Fax: 801-478-2781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number4912606-2501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: