MEDICARE: MERRYWEATHER-O'BANION PSYCHOLOGISTS, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	109053-2501	UT
2	103T00000X	Psychologist	109246-2501	UT

General Provider Information

NPI Number	:	1154464741
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERRYWEATHER-O'BANION PSYCHOLOGISTS, P.C.

Provider Business Mailing Address
First Line	:	2290 EAST 4500 SOUTH
Second Line	:	SUITE 100
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-4493
Country	:	US
Telephone Number	:	801-272-0394
Fax Number	:	801-272-0118

Provider Business Practice Location Address
First Line	:	2290 E 4500 S
Second Line	:	SUITE 100
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-4492
Country	:	US
Telephone Number	:	801-272-0394
Fax Number	:	801-272-0118

Authorized Official
Title or Position	:	PSYCHOLOGIST
Name	:	DR. JOHN FRANCIS MERRYWEATHER
Credential	:	PH.D.
Telephone Number	:	801-272-0394

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	04/24/2009

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