Organization
UTAH STATE UNIVERSITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KATHY J. RECK (OFFICE MANAGER)
(435) 797-2032
Entity
Organization
Contact information
Practice address
2810 OLD MAIN HL, LOGAN, UT 84322-2810
(435) 797-3401
(435) 797-1448
Mailing address
2810 OLD MAIN HL, LOGAN, UT 84322-2810
(435) 797-3401
(435) 797-1448
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
5805022-2501
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5805022250001
BLUE CROSS BLUE SHIELD
UT
Enumeration date
12/12/2006
Last updated
08/22/2020
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