| Life Elevated Psychiatry Llc | |
|
11620 S State St Ste 1403 Draper UT 84020-7124 | |
| (385) 302-7369 | |
| (385) 247-8023 |
| Full Name | Life Elevated Psychiatry Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 11620 S State St Ste 1403, Draper, Utah |
| Authorized Official Name and Position | Brock Haskell (OWNER) |
| Authorized Official Contact | 3853027369 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Elevated Psychiatry Llc 11620 S State St Ste 1403 Draper UT 84020-7124 Ph: (385) 302-7369 | Life Elevated Psychiatry Llc 11620 S State St Ste 1403 Draper UT 84020-7124 Ph: (385) 302-7369 |
| NPI Number | 1063199305 |
|---|---|
| Provider Enumeration Date | 06/29/2023 |
| Last Update Date | 06/29/2023 |
| Certification Date | 06/29/2023 |
| Medicare PECOS PAC ID | 2567825326 |
|---|---|
| Medicare Enrollment ID | O20230825002269 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063199305 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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