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General NPI Number Information
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NPI Number | 1720186307
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Entity Type | Organization
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Legal Business Name | JAMES M OTTESEN PHD INC
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 640 EAST 700 SOUTH SUITE 207
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City | ST. GEORGE
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State | UT
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Zip | 84770-5293
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Country | US
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Telephone | 435-652-0322
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Fax | 435-652-0350
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Provider Business Mailing Address
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Address Line | 640 EAST 700 SOUTH SUITE 207
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City | ST. GEORGE
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State | UT
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Zip | 84770-5293
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Country | US
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Telephone | 435-652-0322
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Fax | 435-652-0350
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAMES M OTTESEN
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Credential | PH.D.
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Telephone | 435-652-0322
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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 | 325458-2501
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License Number State | UT
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