Provider Demographics
NPI:1538948005
Name:PREMIER PSYCHIATRY SOLUTIONS
Entity type:Organization
Organization Name:PREMIER PSYCHIATRY SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SHADRICK
Authorized Official - Middle Name:WYATT
Authorized Official - Last Name:TILLOTSON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:801-404-9662
Mailing Address - Street 1:2901 W BLUE GRASS BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-4190
Mailing Address - Country:US
Mailing Address - Phone:801-404-9662
Mailing Address - Fax:
Practice Address - Street 1:2901 W BLUE GRASS BLVD STE 200
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-4190
Practice Address - Country:US
Practice Address - Phone:801-404-9662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-25
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty