Provider Demographics
NPI:1730661349
Name:CITY CENTER PSYCHOLOGY, PLLC
Entity Type:Organization
Organization Name:CITY CENTER PSYCHOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JINNA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:385-831-0200
Mailing Address - Street 1:175 S MAIN ST STE 840
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-1924
Mailing Address - Country:US
Mailing Address - Phone:385-831-0200
Mailing Address - Fax:
Practice Address - Street 1:175 S MAIN ST STE 840
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-1924
Practice Address - Country:US
Practice Address - Phone:385-831-0200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-30
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)