Provider Demographics
NPI:1679540751
Name:ASSOCIATED CLINICAL & COUNSELING PSYCHOLOGISTS
Entity type:Organization
Organization Name:ASSOCIATED CLINICAL & COUNSELING PSYCHOLOGISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:DODGION
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:801-281-4084
Mailing Address - Street 1:5691 S REDWOOD RD
Mailing Address - Street 2:SUITE 15
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84123-5322
Mailing Address - Country:US
Mailing Address - Phone:801-281-4084
Mailing Address - Fax:801-281-4083
Practice Address - Street 1:5691 S REDWOOD RD
Practice Address - Street 2:SUITE 15
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84123-5322
Practice Address - Country:US
Practice Address - Phone:801-281-4084
Practice Address - Fax:801-281-4083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11181103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty