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General NPI Number Information
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NPI Number | 1053466169
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Entity Type | Individual
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Provider Name | THERESA STUELAND KAY PHD CLINICAL PSYCHOL
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Gender | Female
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5149 S 1500 W
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City | RIVERDALE
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State | UT
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Zip | 84405
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Country | US
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Telephone | 801-475-0402
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Fax | 801-475-7464
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Provider Business Mailing Address
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Address Line | 903 W 1470 N
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City | CLINTON
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State | UT
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Zip | 84015
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Country | US
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Telephone | 801-807-1033
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 49189582501
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License Number State | UT
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