Provider Demographics
NPI:1790552594
Name:COPPER VALLEY PSYCHOLOGY, LLC
Entity Type:Organization
Organization Name:COPPER VALLEY PSYCHOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:801-332-9370
Mailing Address - Street 1:11845 S 700 E STE 104
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-9836
Mailing Address - Country:US
Mailing Address - Phone:801-332-9370
Mailing Address - Fax:
Practice Address - Street 1:11845 S 700 E STE 104
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-9836
Practice Address - Country:US
Practice Address - Phone:801-332-9370
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty