Provider Demographics
NPI:1245052182
Name:ROSELL, PHILIP JAMES
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:JAMES
Last Name:ROSELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2825 E COTTONWOOD PKWY STE 500
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-7060
Mailing Address - Country:US
Mailing Address - Phone:801-448-6195
Mailing Address - Fax:801-992-7150
Practice Address - Street 1:2825 E COTTONWOOD PKWY STE 500
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-7060
Practice Address - Country:US
Practice Address - Phone:801-448-6195
Practice Address - Fax:801-992-7150
Is Sole Proprietor?:No
Enumeration Date:2024-10-31
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst