Provider Demographics
NPI:1003014143
Name:GARY P SAZAMA PHD APC
Entity Type:Organization
Organization Name:GARY P SAZAMA PHD APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-752-8010
Mailing Address - Street 1:150 E 200 N STE O
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-4036
Mailing Address - Country:US
Mailing Address - Phone:435-752-8010
Mailing Address - Fax:
Practice Address - Street 1:150 E 200 N
Practice Address - Street 2:SUITE O
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-6602
Practice Address - Country:US
Practice Address - Phone:435-752-8010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT112064-2504103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty