Healthcare Provider Details

I. General information

NPI: 1912323411
Provider Name (Legal Business Name): NAVINA FORSYTHE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2014
Last Update Date: 02/11/2024
Certification Date: 02/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12215 S HIDDEN VALLEY RD
SANDY UT
84092-5936
US

IV. Provider business mailing address

12215 S HIDDEN VALLEY RD
SANDY UT
84092-5936
US

V. Phone/Fax

Practice location:
  • Phone: 801-597-0120
  • Fax:
Mailing address:
  • Phone: 801-597-0120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number286022-2501
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: