Provider Demographics
NPI:1578113510
Name:RASH, PHILLIP DALE (PHD)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:DALE
Last Name:RASH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1424 W 430 S
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84601-3986
Mailing Address - Country:US
Mailing Address - Phone:385-223-4321
Mailing Address - Fax:
Practice Address - Street 1:1424 W 430 S
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84601-3986
Practice Address - Country:US
Practice Address - Phone:385-223-4321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-11
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT57407092501103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling