Provider Demographics
NPI:1093238743
Name:DELL CENTER
Entity Type:Organization
Organization Name:DELL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:DELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:410-790-7119
Mailing Address - Street 1:8641 RANCH CLUB CT
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-6283
Mailing Address - Country:US
Mailing Address - Phone:410-790-7119
Mailing Address - Fax:
Practice Address - Street 1:1912 SIDEWINDER DR STE 213
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84060-7257
Practice Address - Country:US
Practice Address - Phone:801-447-2666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-24
Last Update Date:2017-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9718974-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty