Provider Demographics
NPI:1720186307
Name:JAMES M OTTESEN PHD INC
Entity Type:Organization
Organization Name:JAMES M OTTESEN PHD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:OTTESEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:435-652-0322
Mailing Address - Street 1:640 EAST 700 SOUTH
Mailing Address - Street 2:SUITE 207
Mailing Address - City:ST. GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-5293
Mailing Address - Country:US
Mailing Address - Phone:435-652-0322
Mailing Address - Fax:435-652-0350
Practice Address - Street 1:640 EAST 700 SOUTH
Practice Address - Street 2:SUITE 207
Practice Address - City:ST. GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-5293
Practice Address - Country:US
Practice Address - Phone:435-652-0322
Practice Address - Fax:435-652-0350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT325458-2501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty