Provider Demographics
NPI:1265636765
Name:CHEN, STEVEN JOHN (PHD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:JOHN
Last Name:CHEN
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 1:1287 HICKENLOOPER WAY
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-7546
Mailing Address - Country:US
Mailing Address - Phone:801-523-9606
Mailing Address - Fax:
Practice Address - Street 1:12660 FORT ST
Practice Address - Street 2:SUITE 103
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-9303
Practice Address - Country:US
Practice Address - Phone:801-816-1801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2719072501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical