Provider Demographics
NPI:1013276559
Name:SPRINGER, BEN (PHD)
Entity type:Individual
Prefix:
First Name:BEN
Middle Name:
Last Name:SPRINGER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:446 E 2010 S
Mailing Address - Street 2:
Mailing Address - City:HEBER CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84032-4457
Mailing Address - Country:US
Mailing Address - Phone:801-706-8861
Mailing Address - Fax:
Practice Address - Street 1:446 E 2010 S
Practice Address - Street 2:
Practice Address - City:HEBER CITY
Practice Address - State:UT
Practice Address - Zip Code:84032-4457
Practice Address - Country:US
Practice Address - Phone:801-706-8861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-03
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT556010103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT556010OtherPROFESSIONAL EDUCATOR LICENSE