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NPI Code Detail

MEDICARE: DR. LAURA LOCKLIN MCCORMICK PSY.D.

MEDICARE:  DR. LAURA LOCKLIN MCCORMICK  PSY.D.
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
1103T00000XPsychologist61784712504UT

General Provider Information

NPI Number : 1225167679
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LAURA LOCKLIN MCCORMICK PSY.D.
Provider Business Mailing Address
First Line : 115 PARKVIEW TER
Second Line :
City : PARK CITY
State : UT
Zip : 84098-5106
Country : US
Telephone Number : 435-901-2537
Fax Number :
Provider Business Practice Location Address
First Line : 2900 S STATE ST
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84115-3880
Country : US
Telephone Number : 801-983-5540
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/03/2007
Last Update Date : 07/08/2007

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Directions to “ DR. LAURA LOCKLIN MCCORMICK PSY.D.” Practice Location

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