Provider Demographics
NPI:1396867479
Name:CHRIS WEHL, PH.D., INC.
Entity Type:Organization
Organization Name:CHRIS WEHL, PH.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:EINING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-350-3503
Mailing Address - Street 1:505 E 200 S
Mailing Address - Street 2:SUITE 303
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-2022
Mailing Address - Country:US
Mailing Address - Phone:801-350-0115
Mailing Address - Fax:801-350-9582
Practice Address - Street 1:505 E 200 S
Practice Address - Street 2:SUITE 303
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-2022
Practice Address - Country:US
Practice Address - Phone:801-350-0115
Practice Address - Fax:801-350-9582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT115392-2501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT562921865004Medicaid
UTU000572OtherTRICARE PROVIDER ID
UT562921865004Medicaid