Provider Demographics
NPI:1417506270
Name:OGDEN PSYCHOLOGICAL SERVICES LLC
Entity Type:Organization
Organization Name:OGDEN PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PETROVICH
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:801-505-6545
Mailing Address - Street 1:1186 E 4600 S STE 110
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-4896
Mailing Address - Country:US
Mailing Address - Phone:801-505-6545
Mailing Address - Fax:801-505-6545
Practice Address - Street 1:1186 E 4600 S STE 110
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-4896
Practice Address - Country:US
Practice Address - Phone:801-505-6545
Practice Address - Fax:801-505-6545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-04
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty