Sideline Sport Psychology Pllc
NPI #1053133322 in Salt Lake City, Utah
Provider Information
- NPI Number
- 1053133322
- Entity Type
- Organization
- Organization Name
- Sideline Sport Psychology Pllc
- Primary Specialty
- Clinic/Center - Adult Mental Health
- Enumeration Date
- Oct 29, 2024
- Last Updated
- Oct 29, 2024
Practice Location
- Address
- 1336 S 1100 E
- City
- Salt Lake City
- State
- Utah
- ZIP Code
- 84105-2421
- Phone
- (385) 899-2251
Authorized Official
- Name
- DR. JOURDAN JOHNSON, EDD, LMFT, CMPC
- Title
- OWNER
- Phone
- (916) 690-0399
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - Adult Mental Health — Adult Mental Health |
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