Healthcare Provider Details

I. General information

NPI: 1487961793
Provider Name (Legal Business Name): PSYCHIATRY CONSULTING & RESEARCH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2010
Last Update Date: 05/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1924 BROADMOOR ST
SALT LAKE CITY UT
84108-3306
US

IV. Provider business mailing address

PO BOX 58251
SALT LAKE CITY UT
84158-0251
US

V. Phone/Fax

Practice location:
  • Phone: 801-230-5899
  • Fax: 801-367-7678
Mailing address:
  • Phone: 801-230-5899
  • Fax: 801-367-7678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number370399-1205
License Number StateUT

VIII. Authorized Official

Name: DR. REID J. ROBISON
Title or Position: OWNER
Credential: M.D.
Phone: 801-230-5899