Organization
PDY CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICIA RUTH DEYOUNG LCSW (PRESIDENT)
(801) 755-0928
Entity
Organization
Contact information
Practice address
2319 S FOOTHILL DR STE 180, SALT LAKE CITY, UT 84109-5403
(801) 755-0928
Mailing address
3232 S 1575 E, SALT LAKE CITY, UT 84106-3355
(801) 755-0928
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
1025453501
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
U000078304
MEDICARE PTAN#
UT
Enumeration date
05/23/2016
Last updated
05/23/2016
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