| South Davis Psychological Services | |
|
520 N Market Place Dr Ste 200 Centerville UT 84014-4904 | |
| (801) 934-3373 | |
| Not Available |
| Full Name | South Davis Psychological Services |
|---|---|
| Speciality | Clinic/Center |
| Location | 520 N Market Place Dr Ste 200, Centerville, Utah |
| Authorized Official Name and Position | Jonathan Ahern (OWNER) |
| Authorized Official Contact | 8019343373 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| South Davis Psychological Services 520 N Market Place Dr Ste 200 Centerville UT 84014-4904 Ph: (801) 934-3373 | South Davis Psychological Services 520 N Market Place Dr Ste 200 Centerville UT 84014-4904 Ph: (801) 934-3373 |
| NPI Number | 1386142396 |
|---|---|
| Provider Enumeration Date | 01/24/2018 |
| Last Update Date | 09/07/2022 |
| Certification Date | 09/07/2022 |
| Medicare PECOS PAC ID | 0446511927 |
|---|---|
| Medicare Enrollment ID | O20180223002317 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386142396 | NPI | - | NPPES |
| 1437400447 | Medicaid | UT |
| Provider Name | Dennis Evard Ahern |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1881674661 PECOS PAC ID: 1850346081 Enrollment ID: I20050321000492 |
| Provider Name | Rachelle Rose |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1265448104 PECOS PAC ID: 3476505504 Enrollment ID: I20070731000563 |
| Provider Name | Bryan Boyd Bushman |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1831346170 PECOS PAC ID: 0749340305 Enrollment ID: I20081201000035 |
| Provider Name | Sheila G Perry |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235295684 PECOS PAC ID: 0446304422 Enrollment ID: I20090811000562 |
| Provider Name | Gary A Goodrich |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1821004821 PECOS PAC ID: 6608035456 Enrollment ID: I20120314000231 |
| Provider Name | Jonathan J Ahern |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1437400447 PECOS PAC ID: 4284887860 Enrollment ID: I20130109000714 |
| Provider Name | Timothy Champlin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1760926901 PECOS PAC ID: 6305181108 Enrollment ID: I20181226001138 |
| Provider Name | Steven N Nickolaisen |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1841857315 PECOS PAC ID: 7214367648 Enrollment ID: I20200424002631 |
| Provider Name | Karen Talbot |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1578972998 PECOS PAC ID: 9335546126 Enrollment ID: I20210921002683 |
| Provider Name | Kelly Kohli |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265843205 PECOS PAC ID: 7911305966 Enrollment ID: I20211006001486 |
| Provider Name | Madeline Claude |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053967752 PECOS PAC ID: 4082090527 Enrollment ID: I20221006000499 |
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