Provider Demographics
NPI:1265467831
Name:NOSANCHUK, MELVIN F (PHD)
Entity Type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:F
Last Name:NOSANCHUK
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 1:1646 KENSINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84105-2806
Mailing Address - Country:US
Mailing Address - Phone:801-467-4875
Mailing Address - Fax:801-467-4875
Practice Address - Street 1:1646 KENSINGTON AVE
Practice Address - Street 2:
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84105-2806
Practice Address - Country:US
Practice Address - Phone:801-467-4875
Practice Address - Fax:801-467-4875
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT106465-2501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical