Provider Demographics
NPI:1730122318
Name:STRATTON, PAUL M (PHD, MBA)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:M
Last Name:STRATTON
Suffix:
Gender:M
Credentials:PHD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 E 100 S STE 120
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-2070
Mailing Address - Country:US
Mailing Address - Phone:801-450-1128
Mailing Address - Fax:
Practice Address - Street 1:525 E 100 S STE 120
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-2070
Practice Address - Country:US
Practice Address - Phone:801-450-1128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6089085-2504103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist