Provider Demographics
NPI:1760532162
Name:SCOTT W. FIDLER, PSY.D.
Entity Type:Organization
Organization Name:SCOTT W. FIDLER, PSY.D.
Other - Org Name:DRAPER PSYCHOLOGY AND COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:FIDLER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:801-619-3569
Mailing Address - Street 1:782 PIONEER RD
Mailing Address - Street 2:SUITE D-1
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-9300
Mailing Address - Country:US
Mailing Address - Phone:801-619-3569
Mailing Address - Fax:801-756-0302
Practice Address - Street 1:12176 S 1000 E STE 8F
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-9734
Practice Address - Country:US
Practice Address - Phone:801-619-3569
Practice Address - Fax:801-576-7540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5338272-2501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty