Basic Information
| Provider Information | |||||||||
| NPI: | 1629230669 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHERLOCK | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2185 BUENA VISTA DR | ||||||||
| Address2: | |||||||||
| City: | MOAB | ||||||||
| State: | UT | ||||||||
| PostalCode: | 845323492 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4352593880 | ||||||||
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| Practice Location | |||||||||
| Address1: | 75 MDG/SGHC | ||||||||
| Address2: | 7321 11TH STREET, BLDG. 570 | ||||||||
| City: | HILL AFB | ||||||||
| State: | UT | ||||||||
| PostalCode: | 84056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8017777909 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2008 | ||||||||
| LastUpdateDate: | 07/01/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 117457-2501 | UT | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.