Organization
FAMILY DEVELOPMENT CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TERRY LEE BURNHAM PHD (PSYCHOLOGIST)
(801) 748-2270
Entity
Organization
Contact information
Practice address
8817 REDWOOD RD STE A, WEST JORDAN, UT 84088-9266
(801) 748-2270
(801) 748-2271
Mailing address
8817 REDWOOD RD STE A, WEST JORDAN, UT 84088-9266
(801) 748-2270
(801) 748-2271
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
108286-2501
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
52954286702001
BCBS OF UTAH
UT
Enumeration date
08/19/2006
Last updated
08/22/2020
Update your record
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