Provider Demographics
NPI:1598212367
Name:OLYMPUS INK SYSTEMS
Entity Type:Organization
Organization Name:OLYMPUS INK SYSTEMS
Other - Org Name:YES CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, YES CLINIC
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:SPENCER
Authorized Official - Last Name:ROBISON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:801-636-2080
Mailing Address - Street 1:396 E 60 S # B
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-3835
Mailing Address - Country:US
Mailing Address - Phone:801-358-4832
Mailing Address - Fax:
Practice Address - Street 1:396 E 60 S # B
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-3835
Practice Address - Country:US
Practice Address - Phone:801-358-4832
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT79798553902101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty