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General NPI Number Information
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NPI Number | 1437666054
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Entity Type | Organization
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Legal Business Name | NOVUM PSYCHOTHERAPY, PC
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Dates
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Enumeration Date | 01/04/2018
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Last Update Date | 01/04/2018
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Provider Practice Location Address
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Address Line | 275 E SOUTH TEMPLE STE 150
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City | SALT LAKE CITY
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State | UT
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Zip | 84111-1270
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Country | US
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Telephone | 314-398-2351
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Fax | 801-853-8237
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Provider Business Mailing Address
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Address Line | 777 E SOUTH TEMPLE APT 8C
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City | SALT LAKE CITY
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State | UT
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Zip | 84102-1272
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Country | US
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Telephone | 314-398-2351
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Fax | 801-853-8237
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Authorized Official
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Title or Position | OWNER/LICENSED PSYCHOLOGIST
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Name | DR. PATRICK JOSEPH LEWIS
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Credential | PSYD
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Telephone | 314-398-2351
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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 | 9289374-2501
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License Number State | UT
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