Provider Demographics
NPI:1154464741
Name:MERRYWEATHER-O'BANION PSYCHOLOGISTS, P.C.
Entity Type:Organization
Organization Name:MERRYWEATHER-O'BANION PSYCHOLOGISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:MERRYWEATHER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:801-272-0394
Mailing Address - Street 1:2290 EAST 4500 SOUTH
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-4493
Mailing Address - Country:US
Mailing Address - Phone:801-272-0394
Mailing Address - Fax:801-272-0118
Practice Address - Street 1:2290 E 4500 S
Practice Address - Street 2:SUITE 100
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117-4492
Practice Address - Country:US
Practice Address - Phone:801-272-0394
Practice Address - Fax:801-272-0118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT109246-2501103T00000X
UT109053-2501103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty