# MOUNTAIN PEDIATRIC PSYCHOLOGY INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174289144
- **Authorized official:** DR. JESSICA ROBNETT PSYD (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (435) 200-3083

## Contact information

- **Practice address:** 3361 BUCKBOARD DR, PARK CITY, UT 84098-5303
- **Practice address phone:** (435) 200-3083
- **Mailing address:** 3361 BUCKBOARD DR, PARK CITY, UT 84098-5303
- **Mailing address phone:** (435) 200-3083

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103T00000X | Psychologist | — | NULL | — |
| 103T00000X | Psychologist | — | — | — |
| 103TC0700X | Clinical Psychologist | — | NULL | — |
| 103TC0700X | Clinical Psychologist | — | — | — |
| 103TC2200X | Clinical Child & Adolescent Psychologist | — | NULL | Yes |
| 103TC2200X | Clinical Child & Adolescent Psychologist | — | — | Yes |
| 103TH0004X | Health Psychologist | — | NULL | — |
| 103TH0004X | Health Psychologist | — | — | — |

## Other

- **Enumeration date:** 11/13/2021
- **Last updated:** 11/13/2021