Douglas Platt Benson II, PSY.D
Individual provider Active NPI Clinical Psychologist · Provo, UT
NPI 1306080544 · NPPES record last updated May 16, 2019
Key facts
- NPI
- 1306080544
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 6866553-2501 (UT)
- Practice address
- 1300 E Center St
Provo, UT 84606-3554 - Phone
- (801) 344-4400
- NPI assigned
- Apr 30, 2009
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Clinical Psychologist
- Education
- Other, 2007
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- State of Utah
Practice addresses (Care Compare)
1300 E Ctr St
Utah State Hospital
Provo, UT 84606-3554
Phone (801) 344-4215
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140716000310 | UT | Practitioner - Clinical Psychologist | 9537384102 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6866553-2501 | UT | MD | Cognitive & Behavioral Psychologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cognitive & Behavioral Psychologist | 103TB0200X | 6866553-2501 | UT | |
| Group Psychotherapy Psychologist | 103TP2701X | 6866553-2501 | UT | |
| Clinical Psychologist | 103TC0700X | 6866553-2501 | UT | Yes |
Addresses
Primary practice location
1300 E Center St
Provo, UT 84606-3554
Mailing address
PO Box 270
Provo, UT 84603-0270
Phone (801) 344-4400
Other providers in Provo, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 16, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.