Provider Demographics
NPI:1013111996
Name:FERRIN, CHARLOTTE J (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHARLOTTE
Middle Name:J
Last Name:FERRIN
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 1:2915 E MILLICENT DR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-2019
Mailing Address - Country:US
Mailing Address - Phone:801-582-4147
Mailing Address - Fax:
Practice Address - Street 1:1399 S 700 E
Practice Address - Street 2:SUITE 11
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84105-2149
Practice Address - Country:US
Practice Address - Phone:801-231-5795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4911648-2501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical