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General NPI Number Information
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NPI Number | 1225766769
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Entity Type | Individual
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Provider Name | JAMES ROBERT PEWITT YANCEY PHD
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Gender | Male
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Dates
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Enumeration Date | 08/11/2022
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Last Update Date | 08/11/2022
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Provider Practice Location Address
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Address Line | 500 FOOTHILL BLVD
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City | SALT LAKE CITY
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State | UT
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Zip | 84148-0001
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Country | US
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Telephone | 850-582-1565
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Fax |
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Provider Business Mailing Address
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Address Line | 230 W NORTH TEMPLE APT 510
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City | SALT LAKE CITY
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State | UT
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Zip | 84103-4813
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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 |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 11926371-2501
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License Number State | UT
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