MEDICARE: UTAH PSYCHOLOGICAL CENTER INC.

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	103TC0700X	Clinical Psychologist	108503-2501	UT

General Provider Information

NPI Number	:	1245437235
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UTAH PSYCHOLOGICAL CENTER INC.

Provider Business Mailing Address
First Line	:	3970 S 700 E STE 12
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-2584
Country	:	US
Telephone Number	:	801-263-0800
Fax Number	:	801-263-0901

Provider Business Practice Location Address
First Line	:	3970 S 700 E STE 12
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-2584
Country	:	US
Telephone Number	:	801-263-0800
Fax Number	:	801-263-0901

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BARBARA T. LIEBRODER
Credential	:	PH.D.
Telephone Number	:	801-263-0800

Provider Enumeration Date	:	07/02/2007
Last Update Date	:	08/22/2020

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