Provider Demographics
NPI:1891006383
Name:SALISBURY, TESSA NICOLE (PHD)
Entity Type:Individual
Prefix:
First Name:TESSA
Middle Name:NICOLE
Last Name:SALISBURY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 E 300 S
Mailing Address - Street 2:SUITE 2B2
Mailing Address - City:SALEM
Mailing Address - State:UT
Mailing Address - Zip Code:84653-9453
Mailing Address - Country:US
Mailing Address - Phone:801-529-6002
Mailing Address - Fax:
Practice Address - Street 1:170 E 300 S
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:UT
Practice Address - Zip Code:84653-9453
Practice Address - Country:US
Practice Address - Phone:801-529-6002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-29
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9165158-2504103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical