Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 4809331-2501 | UT |
N | 103T00000X | Psychologist | 4809331-2501 | UT |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 4809331-2501 | UT |
N | 103TA0700X | Adult Development & Aging Psychologist | 4809331-2501 | UT |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 4809331-2501 | UT |
N | 103G00000X | Clinical Psychologist | 4809331-2501 | UT |
N | 103TC0700X | Clinical Psychologist | 4809331-2501 | UT |
N | 103TC1900X | Counseling Psychologist | 4809331-2501 | UT |
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 4809331-2501 | UT |
N | 103TE1100X | Exercise & Sports Psychologist | 4809331-2501 | UT |
N | 103TF0000X | Family Psychologist | 4809331-2501 | UT |
N | 103TF0200X | Forensic Psychologist | 4809331-2501 | UT |
N | 103TM1800X | Intellectual & Developmental Disabilities | 4809331-2501 | UT |
N | 103TP2701X | Group Psychotherapist | 4809331-2501 | UT |
NPI | 1134393895 |
---|---|
Provider Name | Dr. Earl Seegrist |
First Address | South Jordan, UT 84095-9267 |
Second Address | South Jordan, UT 84095-9267 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2008 |
Last Update Date | 22/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
553174-000 | MAGELLAN (01) |