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General NPI Number Information
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NPI Number | 1295153013
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Entity Type | Organization
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Legal Business Name | UTAH PSYCHOLOGICAL HEALTH, LLC
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Dates
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Enumeration Date | 03/29/2014
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Last Update Date | 04/06/2014
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Provider Practice Location Address
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Address Line | 124 S 400 E SUITE 300
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City | SALT LAKE CITY
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State | UT
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Zip | 84111-2135
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Country | US
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Telephone | 801-355-0188
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Fax | 801-892-0773
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Provider Business Mailing Address
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Address Line | 124 S 400 E SUITE 300
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City | SALT LAKE CITY
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State | UT
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Zip | 84111-2135
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Country | US
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Telephone | 801-355-0188
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Fax | 801-892-0773
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. SEAN CUNNINGHAM
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Credential |
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Telephone | 801-355-0188
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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 | 86373672501
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License Number State | UT
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