Provider Demographics
NPI:1831102490
Name:OTTESEN, JAMES MCBRIDE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MCBRIDE
Last Name:OTTESEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:640 E 700 S
Mailing Address - Street 2:SUITE 207
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-4023
Mailing Address - Country:US
Mailing Address - Phone:435-652-0322
Mailing Address - Fax:435-652-0350
Practice Address - Street 1:640 E 700 S
Practice Address - Street 2:SUITE 207
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-4023
Practice Address - Country:US
Practice Address - Phone:435-652-0322
Practice Address - Fax:435-652-0350
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT96-325458-2501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical