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General NPI Number Information
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NPI Number | 1033533211
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Entity Type | Organization
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Legal Business Name | UTAH STATE HOSPITAL
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Dates
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Enumeration Date | 02/10/2014
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Last Update Date | 02/10/2014
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Provider Practice Location Address
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Address Line | 1300 E CENTER ST
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City | PROVO
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State | UT
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Zip | 84606-3554
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Country | US
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Telephone | 801-344-4331
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Fax |
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Provider Business Mailing Address
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Address Line | 1300 E CENTER ST
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City | PROVO
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State | UT
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Zip | 84606-3554
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | NEUROPSYCHOLOGIST
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Name | DR. ANDREW NICHOLS
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Credential | PH.D.
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Telephone | 801-344-4331
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number | 8651960-2501
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License Number State | UT
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