Provider Demographics
NPI:1689899171
Name:AD PSYCHOTHERAPY AND CLINICAL CONSULTING INC.
Entity Type:Organization
Organization Name:AD PSYCHOTHERAPY AND CLINICAL CONSULTING INC.
Other - Org Name:AD CLINICAL
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:DUSOE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LCSW
Authorized Official - Phone:801-233-8577
Mailing Address - Street 1:8465 S 700 E
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-0501
Mailing Address - Country:US
Mailing Address - Phone:801-233-8577
Mailing Address - Fax:801-233-8748
Practice Address - Street 1:8465 S 700 E
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-0501
Practice Address - Country:US
Practice Address - Phone:801-233-8577
Practice Address - Fax:801-233-8748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12555251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health