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NPI Code Detail

MEDICARE: BEALL PSYCHOLOGICAL SERVICES PC

MEDICARE: BEALL PSYCHOLOGICAL SERVICES PC
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
1103TC0700XClinical Psychologist270228-2501UT

General Provider Information

NPI Number : 1952619397
Entity Type Code : Organization
Provider Name (Legal Business Name) : BEALL PSYCHOLOGICAL SERVICES PC
Provider Business Mailing Address
First Line : PO BOX 902650
Second Line :
City : SANDY
State : UT
Zip : 84090-2650
Country : US
Telephone Number : 801-897-5474
Fax Number : 801-263-6370
Provider Business Practice Location Address
First Line : 32 W WINCHESTER ST
Second Line : SUITE 101
City : SALT LAKE CITY
State : UT
Zip : 84107-5607
Country : US
Telephone Number : 801-897-5474
Fax Number :
Authorized Official
Title or Position : DIRECTOR/PRESIDENT
Name : LAWRENCE DALTON BEALL
Credential : PH,D.
Telephone Number : 801-897-5474
Provider Enumeration Date : 09/20/2010
Last Update Date : 08/15/2022

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