Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 9524802-2501 | UT |
Y | 103TC0700X | Clinical Psychologist | 9524802-2501 | UT |
N | 102L00000X | Psychologist | 9524802-2501 | UT |
N | 103T00000X | Psychologist | 9524802-2501 | UT |
N | 103TA0700X | Adult Development & Aging Psychologist | 9524802-2501 | UT |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 9524802-2501 | UT |
N | 103G00000X | Clinical Psychologist | 9524802-2501 | UT |
N | 103TC0700X | Clinical Psychologist | 9524802-2501 | UT |
N | 103TF0200X | Forensic Psychologist | 9524802-2501 | UT |
N | 103TH0100X | Health Service | 9524802-2501 | UT |
N | 103TM1800X | Intellectual & Developmental Disabilities | 9524802-2501 | UT |
NPI | 1154565729 |
---|---|
Provider Name | Dr. Keith Mcgoldrick |
First Address | Salt Lake City, UT 84105-3482 |
Second Address | Salt Lake City, UT 84105-3482 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2009 |
Last Update Date | 05/11/2019 |