Provider Demographics
NPI:1326080367
Name:ADAMS, DAVID B (PHD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:B
Last Name:ADAMS
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 1:1036 COUNTRYLANE RD
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-4158
Mailing Address - Country:US
Mailing Address - Phone:801-261-1157
Mailing Address - Fax:
Practice Address - Street 1:6925 UNION PARK CTR
Practice Address - Street 2:SUITE 490
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-4142
Practice Address - Country:US
Practice Address - Phone:801-566-2622
Practice Address - Fax:801-566-0536
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT108342-2501103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTR34232Medicare UPIN