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Organization
MOUNTAIN PEDIATRIC PSYCHOLOGY INC
Active
Organization
MOUNTAIN PEDIATRIC PSYCHOLOGY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JESSICA ROBNETT PSYD (EXECUTIVE DIRECTOR)
(435) 200-3083
Entity
Organization
Contact information
Practice address
3361 BUCKBOARD DR, PARK CITY, UT 84098-5303
(435) 200-3083
Mailing address
3361 BUCKBOARD DR, PARK CITY, UT 84098-5303
(435) 200-3083
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
NULL
103T00000X
Psychologist
—
—
103TC0700X
Clinical Psychologist
—
NULL
103TC0700X
Clinical Psychologist
—
—
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
—
NULL
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
—
—
103TH0004X
Health Psychologist
—
NULL
103TH0004X
Health Psychologist
—
—
Other
Enumeration date
11/13/2021
Last updated
11/13/2021
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