Provider Demographics
NPI:1750749958
Name:ADVENTURPSYCH, PLLC
Entity type:Organization
Organization Name:ADVENTURPSYCH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:S
Authorized Official - Last Name:POLK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:801-285-7725
Mailing Address - Street 1:9980 S 300 W
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-3627
Mailing Address - Country:US
Mailing Address - Phone:801-285-7725
Mailing Address - Fax:801-285-7726
Practice Address - Street 1:9980 S 300 W
Practice Address - Street 2:SUITE 200
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-3627
Practice Address - Country:US
Practice Address - Phone:801-285-7725
Practice Address - Fax:801-285-7726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty