NPIMap

Organization Active NPI

University of Utah

  • Addiction (Substance Use Disorder) Psychologist
  • Salt Lake City, UT
National Provider Identifier
1194070276
Registry record updated Jul 16, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) PsychologistTaxonomy code 103TA0400X
Legal business name
UNIVERSITY OF UTAH
Practice address
450 S 900 E
Suite 300
Salt Lake City, UT 84102-2981
Phone
(801) 532-1850
Fax
(801) 532-3608
NPI assigned
Jul 16, 2012
Organization subpart
Yes
Parent organization
UNIVERSITY OF UTAHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 16, 2012

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

Authorized official

Name
Dr. Kelly Lundberg, PHD
Title
Director
Phone
(801) 534-7905

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103TA0400X UT Primary

Addresses

Primary practice location

450 S 900 E
Suite 300
Salt Lake City, UT 84102-2981

Mailing address

450 S 900 E
Suite 300
Salt Lake City, UT 84102-3608
Phone (801) 532-1850

Other names 1

  • Assessment & Referral Services Doing business as

National Provider Directory

National Provider Directory
Tax ID family
University of Utah Psyc3 organizations share this tax ID, including this one
Part of
University of Utah Psyc

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1342396800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1342396800000",
    "number": "1194070276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 S 900 E",
            "address_2": "SUITE 300",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841023608",
            "telephone_number": "801-532-1850",
            "fax_number": "801-532-3608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 S 900 E",
            "address_2": "SUITE 300",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841022981",
            "telephone_number": "801-532-1850",
            "fax_number": "801-532-3608"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY OF UTAH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "UNIVERSITY OF UTAH",
        "enumeration_date": "2012-07-16",
        "last_updated": "2012-07-16",
        "status": "A",
        "authorized_official_last_name": "LUNDBERG",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "801-534-7905",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TA0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": "UT",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Assessment & Referral Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Salt Lake City, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2012; 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.