Provider Demographics
NPI:1821814930
Name:GRAND VALLEY PSYCHIATRY
Entity type:Organization
Organization Name:GRAND VALLEY PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:
Authorized Official - Last Name:FIEDEL
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:801-815-2068
Mailing Address - Street 1:2639 W 13220 S
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-2279
Mailing Address - Country:US
Mailing Address - Phone:801-815-2068
Mailing Address - Fax:610-850-6778
Practice Address - Street 1:2639 W 13220 S
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-2279
Practice Address - Country:US
Practice Address - Phone:801-815-2068
Practice Address - Fax:610-850-6778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-23
Last Update Date:2024-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty