| Ogden Psychological Services Llc | |
|
1186 E 4600 S Ste 110 Ogden UT 84403-4896 | |
| (801) 505-6545 | |
| (801) 505-6545 |
| Full Name | Ogden Psychological Services Llc |
|---|---|
| Speciality | Psychologist |
| Location | 1186 E 4600 S Ste 110, Ogden, Utah |
| Authorized Official Name and Position | Brian Petrovich (CLINICAL DIRECTOR) |
| Authorized Official Contact | 8015056545 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ogden Psychological Services Llc 1186 E 4600 S Ste 110 Ogden UT 84403-4896 Ph: (801) 505-6545 | Ogden Psychological Services Llc 1186 E 4600 S Ste 110 Ogden UT 84403-4896 Ph: (801) 505-6545 |
| NPI Number | 1417506270 |
|---|---|
| Provider Enumeration Date | 09/04/2019 |
| Last Update Date | 05/16/2022 |
| Certification Date | 05/16/2022 |
| Medicare PECOS PAC ID | 3072844505 |
|---|---|
| Medicare Enrollment ID | O20191014001986 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417506270 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Brian Dion Petrovich |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1336110568 PECOS PAC ID: 3870520240 Enrollment ID: I20191025002132 |
| Provider Name | Christina A. Franco |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1790215184 PECOS PAC ID: 2769813534 Enrollment ID: I20200511002798 |
| Provider Name | Steven R Sorenson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114004306 PECOS PAC ID: 6608296389 Enrollment ID: I20201019001914 |
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