Provider Demographics
NPI:1881750644
Name:MCWHORTER, PATRICIA JEAN (PHD LICENSED PSYCHOL)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:JEAN
Last Name:MCWHORTER
Suffix:
Gender:F
Credentials:PHD LICENSED PSYCHOL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-2132
Mailing Address - Country:US
Mailing Address - Phone:435-843-7060
Mailing Address - Fax:435-843-9548
Practice Address - Street 1:40 S MAIN ST
Practice Address - Street 2:
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-2132
Practice Address - Country:US
Practice Address - Phone:435-843-7060
Practice Address - Fax:435-843-9548
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3171762501103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000060684Medicare PIN
S87138Medicare UPIN