Provider Demographics
NPI:1831376037
Name:NEWBOLD, DAVID (PHD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:NEWBOLD
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:PO BOX 212
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-0212
Mailing Address - Country:US
Mailing Address - Phone:801-776-1954
Mailing Address - Fax:801-774-9602
Practice Address - Street 1:370 S 500 E
Practice Address - Street 2:SUITE 180
Practice Address - City:CLEARFIELD
Practice Address - State:UT
Practice Address - Zip Code:84015-4057
Practice Address - Country:US
Practice Address - Phone:801-776-1954
Practice Address - Fax:801-774-9602
Is Sole Proprietor?:No
Enumeration Date:2008-01-30
Last Update Date:2019-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT112204-2501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical