NPIMap

Organization Active NPI

Ted a. Harris, PHD, Licensed Psychologist, Inc.

  • Clinical Psychologist
  • Taylorsville, UT
National Provider Identifier
1487768826
Registry record updated Nov 24, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
91-116205-2501 Issued in UT
Legal business name
TED A. HARRIS, PHD, LICENSED PSYCHOLOGIST, INC.
Practice address
5691 S Redwood Rd # 16
Taylorsville, UT 84123-5322
Phone
(801) 265-3895
Fax
(801) 263-1265
NPI assigned
Aug 19, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 24, 2008

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

Authorized official

Name
Mr. Ted A Harris, PHDNPI 1033186382
Title
Psychologist
Phone
(801) 265-3895

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 PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X 91-116205-2501 UT Primary

Addresses

Primary practice location

5691 S Redwood Rd # 16
Taylorsville, UT 84123-5322

Mailing address

5691 S Redwood Rd # 16
Taylorsville, UT 84123-5322
Phone (801) 265-3895

Other identifiers 1

IdentifierTypeStateIssuer
52806017403001OtherUTBCBS OF UTAH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031111000369 UT Part B Supplier - Clinic/Group Practice 5890608236 Receives reassigned benefits from 3 practitioners
Practice locations: Taylorsville, UT

National Provider Directory

National Provider Directory

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": "1155945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1227484800000",
    "number": "1487768826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5691 S REDWOOD RD # 16",
            "city": "TAYLORSVILLE",
            "state": "UT",
            "postal_code": "841235322",
            "telephone_number": "801-265-3895",
            "fax_number": "801-263-1265"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5691 S REDWOOD RD # 16",
            "city": "TAYLORSVILLE",
            "state": "UT",
            "postal_code": "841235322",
            "telephone_number": "801-265-3895",
            "fax_number": "801-263-1265"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TED A. HARRIS, PHD, LICENSED PSYCHOLOGIST, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-19",
        "last_updated": "2008-11-24",
        "status": "A",
        "authorized_official_last_name": "HARRIS",
        "authorized_official_first_name": "TED",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PSYCHOLOGIST",
        "authorized_official_telephone_number": "801-265-3895",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "UT",
            "license": "91-116205-2501",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF UTAH",
            "identifier": "52806017403001",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Taylorsville, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.