Provider Demographics
NPI:1073930699
Name:SUZANNE TYNDALL PH.D. LLC
Entity Type:Organization
Organization Name:SUZANNE TYNDALL PH.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:TYNDALL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:801-906-8336
Mailing Address - Street 1:150 S 600 E
Mailing Address - Street 2:AMBASSADOR PLAZA SUITE 8C
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1999
Mailing Address - Country:US
Mailing Address - Phone:801-906-8336
Mailing Address - Fax:
Practice Address - Street 1:150 S 600 E
Practice Address - Street 2:AMBASSADOR PLAZA SUITE 8C
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1999
Practice Address - Country:US
Practice Address - Phone:801-906-8336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-20
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty