Provider Demographics
NPI:1952619397
Name:BEALL PSYCHOLOGICAL SERVICES PC
Entity Type:Organization
Organization Name:BEALL PSYCHOLOGICAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:DALTON
Authorized Official - Last Name:BEALL
Authorized Official - Suffix:
Authorized Official - Credentials:PH,D
Authorized Official - Phone:801-897-5474
Mailing Address - Street 1:PO BOX 902650
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84090-2650
Mailing Address - Country:US
Mailing Address - Phone:801-897-5474
Mailing Address - Fax:801-263-6370
Practice Address - Street 1:32 W WINCHESTER ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-5607
Practice Address - Country:US
Practice Address - Phone:801-897-5474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-20
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT270228-2501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty