Provider Demographics
NPI:1952466690
Name:ASSOCIATION FOR PERSONAL DEVELOPMENT PC
Entity Type:Organization
Organization Name:ASSOCIATION FOR PERSONAL DEVELOPMENT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANN
Authorized Official - Middle Name:F
Authorized Official - Last Name:PRITT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:801-544-1166
Mailing Address - Street 1:690 E CENTER ST
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-2137
Mailing Address - Country:US
Mailing Address - Phone:801-544-1166
Mailing Address - Fax:801-544-6558
Practice Address - Street 1:447 N 300 W
Practice Address - Street 2:STE 7
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-4203
Practice Address - Country:US
Practice Address - Phone:801-529-7087
Practice Address - Fax:801-544-6558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT(94)14101735011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTR58087Medicare UPIN
UT000055902Medicare PIN