NPIMap

Organization Active NPI

Utah State University

  • Clinical Psychologist
  • Logan, UT
National Provider Identifier
1811058076
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
5805022-2501 Issued in UT
Legal business name
UTAH STATE UNIVERSITY
Practice address
2810 Old Main HL
Logan, UT 84322-2810
Phone
(435) 797-3401
Fax
(435) 797-1448
NPI assigned
Dec 12, 2006
Last updated
Aug 22, 2020By the provider in NPPES
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
Ms. Kathy J. Reck
Title
Office Manager
Phone
(435) 797-2032

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 5805022-2501 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

IdentifierTypeStateIssuer
5805022250001OtherUTBLUE CROSS BLUE SHIELD

National Provider Directory

National Provider Directory
Tax ID family
Utah State University Center for Persons With Disabilities12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1811058076",
    "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": {
        "organization_name": "UTAH STATE UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "RECK",
        "authorized_official_first_name": "KATHY",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "435-797-2032",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "UT",
            "license": "5805022-2501",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "5805022250001",
            "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 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.