Provider Demographics
NPI:1578643771
Name:DAVID NEWBOLD PHD & ASSOCIATES, LLC
Entity Type:Organization
Organization Name:DAVID NEWBOLD PHD & ASSOCIATES, LLC
Other - Org Name:DAVID NEWBOLD, PHD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWBOLD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:801-776-1954
Mailing Address - Street 1:PO BOX 212
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-0212
Mailing Address - Country:US
Mailing Address - Phone:801-776-1954
Mailing Address - Fax:801-774-9602
Practice Address - Street 1:370 S 500 E
Practice Address - Street 2:SUITE 180
Practice Address - City:CLEARFIELD
Practice Address - State:UT
Practice Address - Zip Code:84015-4057
Practice Address - Country:US
Practice Address - Phone:801-776-1954
Practice Address - Fax:801-774-9602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT841122042501103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT529780736017Medicaid
UT529780736017Medicaid