Active NPI
Michael Scott Deberard, PHD, M.S., B.A.
- Clinical Psychologist
- Logan, UT
National Provider Identifier
1568581056
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 50289442501
- Practice address
- 2810 Old Main HL
Logan, UT 84322-2810 - Phone
- (435) 797-3401
- Fax
- (435) 797-1448
- NPI assigned
- Mar 28, 2007
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 50289442501 | UT | Primary |
Addresses
Primary practice location
2810 Old Main HL
Logan, UT 84322-2810
Mailing address
2810 Old Main HL
Logan, UT 84322-2810
Phone (435) 797-3401
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 50289442500001 | Other | UT | BCBS PROVIDER NUMBER |
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
- Bachelor of Arts, Master of Science, Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 50289442501 | UT | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175040000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1568581056",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2810 OLD MAIN HL",
"city": "LOGAN",
"state": "UT",
"postal_code": "843222810",
"telephone_number": "435-797-3401",
"fax_number": "435-797-1448"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2810 OLD MAIN HL",
"city": "LOGAN",
"state": "UT",
"postal_code": "843222810",
"telephone_number": "435-797-3401",
"fax_number": "435-797-1448"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEBERARD",
"first_name": "MICHAEL",
"middle_name": "SCOTT",
"credential": "PHD, M.S., B.A.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "UT",
"license": "50289442501",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS PROVIDER NUMBER",
"identifier": "50289442500001",
"state": "UT"
}
],
"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.