Provider Demographics
NPI:1972093789
Name:PSYCHOLOGICAL ASSESSMENT & INTERVENTION RESOURCES, PC
Entity Type:Organization
Organization Name:PSYCHOLOGICAL ASSESSMENT & INTERVENTION RESOURCES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAPACZ
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:801-822-9542
Mailing Address - Street 1:922 W BAXTER DR STE 260
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-8626
Mailing Address - Country:US
Mailing Address - Phone:801-822-9542
Mailing Address - Fax:
Practice Address - Street 1:922 W BAXTER DR STE 260
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-8626
Practice Address - Country:US
Practice Address - Phone:801-822-9542
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10160877-0144103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty