| Dynamic Psychiatry Pllc | |
|
1654 W Reunion Ave Ste 10b South Jordan UT 84095-4676 | |
| (406) 404-6815 | |
| Not Available |
| Full Name | Dynamic Psychiatry Pllc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1654 W Reunion Ave Ste 10b, South Jordan, Utah |
| Authorized Official Name and Position | Hans Watson (OWNER) |
| Authorized Official Contact | 8013492480 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dynamic Psychiatry Pllc 1654 W Reunion Ave Ste 10b South Jordan UT 84095-4676 Ph: (801) 349-2480 | Dynamic Psychiatry Pllc 1654 W Reunion Ave Ste 10b South Jordan UT 84095-4676 Ph: (406) 404-6815 |
| NPI Number | 1679225536 |
|---|---|
| Provider Enumeration Date | 01/21/2022 |
| Last Update Date | 01/31/2023 |
| Certification Date | 01/31/2023 |
| Medicare PECOS PAC ID | 0840667614 |
|---|---|
| Medicare Enrollment ID | O20221108000708 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679225536 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Benjamin R Eliason |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1659418267 PECOS PAC ID: 4789764317 Enrollment ID: I20170630001006 |
| Provider Name | Tyler G Coe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437533270 PECOS PAC ID: 7214244391 Enrollment ID: I20190410002414 |
| Provider Name | Carla Lucile Applegate-anderson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245877448 PECOS PAC ID: 9032526173 Enrollment ID: I20210430001165 |
| Provider Name | Hans R Watson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1508111337 PECOS PAC ID: 6709014137 Enrollment ID: I20221108000785 |
| Provider Name | Jose D Lopez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1699100081 PECOS PAC ID: 3577934843 Enrollment ID: I20230124002489 |
| Provider Name | Tyler Coe Mcdaniel |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1558829408 PECOS PAC ID: 0042682361 Enrollment ID: I20230215001720 |
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