Active NPI
Roueida Ghadban, PHD CLINICAL PSYCHOL
- Psychologist
- Logan, UT
National Provider Identifier
1558452003
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 62139522501
- Practice address
- 90 East 200 North
Bear River Mental Health
Logan, UT 84321 - Phone
- (435) 752-0750
- Fax
- (435) 752-7433
- NPI assigned
- Sep 28, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 62139522501 | UT | Primary |
Addresses
Primary practice location
90 East 200 North
Bear River Mental Health
Logan, UT 84321
Mailing address
358 North Gateway Dr
#224
Providence, UT 84332
Phone (435) 227-0506
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 62139522501 | UT | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159401600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1558452003",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "358 NORTH GATEWAY DR",
"address_2": "#224",
"city": "PROVIDENCE",
"state": "UT",
"postal_code": "84332",
"telephone_number": "435-227-0506"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "90 EAST 200 NORTH",
"address_2": "BEAR RIVER MENTAL HEALTH",
"city": "LOGAN",
"state": "UT",
"postal_code": "84321",
"telephone_number": "435-752-0750",
"fax_number": "435-752-7433"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GHADBAN",
"first_name": "ROUEIDA",
"name_prefix": "Ms.",
"credential": "PHD CLINICAL PSYCHOL",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "UT",
"license": "62139522501",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Logan, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.