Provider Demographics
NPI:1326634429
Name:DYE, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:DYE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 13 BOX 3086
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:UT
Mailing Address - Zip Code:84623-5000
Mailing Address - Country:US
Mailing Address - Phone:385-236-1382
Mailing Address - Fax:
Practice Address - Street 1:14430 NORTH 2820 EAST
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:UT
Practice Address - Zip Code:84623-5000
Practice Address - Country:US
Practice Address - Phone:385-236-1382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT266252-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical