| Canyon Ridge Psychology Llc | |
|
455 N University Ave Ste 201 Provo UT 84601-2867 | |
| (801) 252-5122 | |
| Not Available |
| Full Name | Canyon Ridge Psychology Llc |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 455 N University Ave Ste 201, Provo, Utah |
| Authorized Official Name and Position | Jason Lefrandt (LICENSED PSYCHOLOGIST) |
| Authorized Official Contact | 8012525122 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Canyon Ridge Psychology Llc 455 N University Ave Ste 201 Provo UT 84601-2867 Ph: (801) 252-5122 | Canyon Ridge Psychology Llc 455 N University Ave Ste 201 Provo UT 84601-2867 Ph: (801) 252-5122 |
| NPI Number | 1841022795 |
|---|---|
| Provider Enumeration Date | 08/19/2024 |
| Last Update Date | 08/19/2024 |
| Certification Date | 08/19/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841022795 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
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