Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 4912036-2501 | UT |
N | 103T00000X | Psychologist | 4912036-2501 | UT |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 4912036-2501 | UT |
N | 103G00000X | Clinical Psychologist | 4912036-2501 | UT |
N | 103TC0700X | Clinical Psychologist | 4912036-2501 | UT |
NPI | 1134107881 |
---|---|
Provider Name | Dr. Christopher Brendan Hallett |
First Address | Salt Lake City, UT 84103-1733 |
Second Address | Salt Lake City, UT 84121-1720 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
107015235101 | INTERMOUNTAIN HEALTH CARE (01) | UT |
780734 | DESERET MUTUAL (01) | UT |