Provider Demographics
NPI:1821037359
Name:BINKS, PAUL G (PHD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:G
Last Name:BINKS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2888 ROCK CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-7946
Mailing Address - Country:US
Mailing Address - Phone:801-502-9552
Mailing Address - Fax:801-253-8094
Practice Address - Street 1:2888 ROCK CREEK DR
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-7946
Practice Address - Country:US
Practice Address - Phone:801-502-9552
Practice Address - Fax:801-253-8094
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5897985-2501103TC0700X
MI6301010097103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P51837Medicare UPIN
MIM74240007Medicare PIN