NPIMap

Organization Active NPI

Professional Clinical Management

  • Psychologist
  • Provo, UT
National Provider Identifier
1023263191
Registry record updated Nov 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
851131532501 Issued in UT
Legal business name
PROFESSIONAL CLINICAL MANAGEMENT
Practice address
1355 N University Ave Ste 200
Provo, UT 84604-2721
Phone
(801) 221-0223
Fax
(801) 221-0291
NPI assigned
Nov 17, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Randall F Hyde, PH.D.NPI 1265526347
Title
Clinical Director
Phone
(801) 221-0223

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103T00000X 851131532501 UT Primary

Addresses

Primary practice location

1355 N University Ave Ste 200
Provo, UT 84604-2721

Mailing address

1355 N University Ave Ste 200
Provo, UT 84604-2721
Phone (801) 221-0223

Other names 1

  • Preferred Family Clinic Doing business as

National Provider Directory

National Provider Directory

Locations

1355 N University Ave
Ste 200
Provo, UT 84604
Phone (801) 221-0223

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 16

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1226880000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1226880000000",
    "number": "1023263191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1355 N UNIVERSITY AVE STE 200",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846042721",
            "telephone_number": "801-221-0223",
            "fax_number": "801-221-0291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1355 N UNIVERSITY AVE STE 200",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846042721",
            "telephone_number": "801-221-0223",
            "fax_number": "801-221-0291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL CLINICAL MANAGEMENT",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-17",
        "last_updated": "2008-11-17",
        "status": "A",
        "authorized_official_last_name": "HYDE",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "801-221-0223",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "UT",
            "license": "851131532501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Preferred Family Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Provo, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.