Provider Demographics
NPI:1073791729
Name:PEAY, THOMAS ROGER (PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ROGER
Last Name:PEAY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2559 ASPEN SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84060-7538
Mailing Address - Country:US
Mailing Address - Phone:801-376-8775
Mailing Address - Fax:435-604-0461
Practice Address - Street 1:2559 ASPEN SPRINGS DR
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84060-7538
Practice Address - Country:US
Practice Address - Phone:801-376-8775
Practice Address - Fax:435-604-0461
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT113517-3902101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional