| Novum Psychotherapy, Pc | |
|
275 E South Temple Ste 150 Salt Lake City UT 84111-1270 | |
| (314) 398-2351 | |
| (801) 853-8237 |
| Full Name | Novum Psychotherapy, Pc |
|---|---|
| Speciality | Psychologist |
| Location | 275 E South Temple Ste 150, Salt Lake City, Utah |
| Authorized Official Name and Position | Patrick Joseph Lewis (OWNER/LICENSED PSYCHOLOGIST) |
| Authorized Official Contact | 3143982351 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Novum Psychotherapy, Pc 777 E South Temple Apt 8c Salt Lake City UT 84102-1272 Ph: (314) 398-2351 | Novum Psychotherapy, Pc 275 E South Temple Ste 150 Salt Lake City UT 84111-1270 Ph: (314) 398-2351 |
| NPI Number | 1437666054 |
|---|---|
| Provider Enumeration Date | 01/04/2018 |
| Last Update Date | 01/04/2018 |
| Medicare PECOS PAC ID | 4082973482 |
|---|---|
| Medicare Enrollment ID | O20180110001162 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437666054 | NPI | - | NPPES |
| 1275846412 | Medicaid | WY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | 9289374-2501 (Utah) | Primary |
| Provider Name | Patrick Joseph Lewis |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1275846412 PECOS PAC ID: 3870618325 Enrollment ID: I20180110001929 |
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