Organization
PROFESSIONAL CLINICAL MANAGEMENT
Active
Other names
Preferred Family Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RANDALL F HYDE PH.D. (CLINICAL DIRECTOR)
(801) 221-0223
Entity
Organization
Contact information
Practice address
1355 N UNIVERSITY AVE STE 200, PROVO, UT 84604-2721
(801) 221-0223
(801) 221-0291
Mailing address
1355 N UNIVERSITY AVE STE 200, PROVO, UT 84604-2721
(801) 221-0223
(801) 221-0291
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
851131532501
UT
Other
Enumeration date
11/17/2008
Last updated
11/17/2008
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