NPIMap

Organization Active NPI

Psychological Assessment & Treatment Specialists, Inc

  • Clinical Child & Adolescent Psychologist
  • American Fork, UT
National Provider Identifier
1417038951
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X
License
276564-2501 Issued in UT
Legal business name
PSYCHOLOGICAL ASSESSMENT & TREATMENT SPECIALISTS, INC
Practice address
814 Bamberger Dr
Suite B
American Fork, UT 84003-2165
Phone
(801) 772-0202
Fax
(801) 772-0139
NPI assigned
Oct 18, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Steven M Gentry, PHDNPI 1407983588
Title
President/Executive Director
Phone
(801) 772-0202

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
Clinical Child & Adolescent PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC2200X 276564-2501 UT Primary

Addresses

Primary practice location

814 Bamberger Dr
Suite B
American Fork, UT 84003-2165

Mailing address

814 Bamberger Dr
Suite B
American Fork, UT 84003-2165
Phone (801) 772-0202

Other identifiers 1

IdentifierTypeStateIssuer
529217859009MedicaidUT

National Provider Directory

National Provider Directory

Locations

814 E Bamberger Dr
Ste B
American Fork, UT 84003
Phone (801) 772-0202

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1417038951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "814 BAMBERGER DR",
            "address_2": "SUITE B",
            "city": "AMERICAN FORK",
            "state": "UT",
            "postal_code": "840032165",
            "telephone_number": "801-772-0202",
            "fax_number": "801-772-0139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "814 BAMBERGER DR",
            "address_2": "SUITE B",
            "city": "AMERICAN FORK",
            "state": "UT",
            "postal_code": "840032165",
            "telephone_number": "801-772-0202",
            "fax_number": "801-772-0139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSYCHOLOGICAL ASSESSMENT & TREATMENT SPECIALISTS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GENTRY",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT/EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "801-772-0202",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "UT",
            "license": "276564-2501",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "529217859009",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in American Fork, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.