Provider Demographics
NPI:1528232865
Name:CLINICAL PSYCHOLOGY SERVICES, INC.
Entity Type:Organization
Organization Name:CLINICAL PSYCHOLOGY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:DAY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD PSYCHOLOGIST
Authorized Official - Phone:801-897-3957
Mailing Address - Street 1:9500 S 1400 E
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84092-2906
Mailing Address - Country:US
Mailing Address - Phone:801-897-3957
Mailing Address - Fax:801-665-1412
Practice Address - Street 1:9500 S 1400 E
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84092-2906
Practice Address - Country:US
Practice Address - Phone:801-897-3957
Practice Address - Fax:801-665-1412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT54057942501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty