Healthcare Provider Details

I. General information

NPI: 1033361654
Provider Name (Legal Business Name): DAVID STEIN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2008
Last Update Date: 11/05/2021
Certification Date: 11/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3522 W 1450 N
WEST POINT UT
84015-7337
US

IV. Provider business mailing address

3522 W 1450 N
WEST POINT UT
84015-7337
US

V. Phone/Fax

Practice location:
  • Phone: 435-512-7759
  • Fax:
Mailing address:
  • Phone: 435-512-7759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number115548-2501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: