Provider Demographics
NPI:1437149838
Name:O'BANION, KATY L (PHD)
Entity Type:Individual
Prefix:DR
First Name:KATY
Middle Name:L
Last Name:O'BANION
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2290 E 4500 S
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-4492
Mailing Address - Country:US
Mailing Address - Phone:801-272-0390
Mailing Address - Fax:801-272-0118
Practice Address - Street 1:2290 E 4500 S
Practice Address - Street 2:SUITE 100
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84117-4492
Practice Address - Country:US
Practice Address - Phone:801-272-0390
Practice Address - Fax:801-272-0118
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1090532501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTR61006Medicare UPIN