| Sideline Sport Psychology Pllc | |
|
1336 S 1100 E Salt Lake City UT 84105-2421 | |
| (385) 899-2251 | |
| Not Available |
| Full Name | Sideline Sport Psychology Pllc |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 1336 S 1100 E, Salt Lake City, Utah |
| Authorized Official Name and Position | Jourdan Johnson (OWNER) |
| Authorized Official Contact | 9166900399 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Sideline Sport Psychology Pllc 4715 S Bron Breck St Holladay UT 84117-6403 Ph: (916) 690-6482 | Sideline Sport Psychology Pllc 1336 S 1100 E Salt Lake City UT 84105-2421 Ph: (385) 899-2251 |
| NPI Number | 1053133322 |
|---|---|
| Provider Enumeration Date | 10/29/2024 |
| Last Update Date | 10/29/2024 |
| Certification Date | 10/29/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053133322 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
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