Provider Demographics
NPI:1649860644
Name:PSYCHOLOGY SPECIALISTS OF UTAH LLC
Entity type:Organization
Organization Name:PSYCHOLOGY SPECIALISTS OF UTAH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:EDGINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:405-315-5756
Mailing Address - Street 1:87 N 600 E
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84014-2020
Mailing Address - Country:US
Mailing Address - Phone:405-315-5756
Mailing Address - Fax:
Practice Address - Street 1:87 N 600 E
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:UT
Practice Address - Zip Code:84014-2020
Practice Address - Country:US
Practice Address - Phone:405-315-5756
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty