Provider Demographics
NPI:1275523730
Name:LIND, MICHAEL JAMES (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JAMES
Last Name:LIND
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 1:2100 BENGAL BLVD
Mailing Address - Street 2:APT. K303
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-7135
Mailing Address - Country:US
Mailing Address - Phone:801-943-3409
Mailing Address - Fax:801-478-2781
Practice Address - Street 1:1545 E 3300 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-3370
Practice Address - Country:US
Practice Address - Phone:801-478-2780
Practice Address - Fax:801-478-2781
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4912606-2501103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTQ06171OtherSTERLING
UT49126062500001OtherBLUE CROSS/BLUE SHIELD
UT49126062500001OtherBLUE CROSS/BLUE SHIELD