Provider Demographics
NPI:1497054506
Name:UTAH PSYCHOLOGICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:UTAH PSYCHOLOGICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRILL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:801-209-6415
Mailing Address - Street 1:3325 N UNIVERSITY AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-4465
Mailing Address - Country:US
Mailing Address - Phone:801-377-2014
Mailing Address - Fax:801-374-7449
Practice Address - Street 1:3325 N UNIVERSITY AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-4465
Practice Address - Country:US
Practice Address - Phone:801-377-2014
Practice Address - Fax:801-374-7449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X, 1041C0700X, 106H00000X
UT5637060-2501103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty