Healthcare Provider Details

I. General information

NPI: 1629862693
Provider Name (Legal Business Name): BENJAMIN HARMON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2025
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 N TRIUMPH BLVD STE 500
LEHI UT
84043-6475
US

IV. Provider business mailing address

3300 N TRIUMPH BLVD STE 500
LEHI UT
84043-6475
US

V. Phone/Fax

Practice location:
  • Phone: 801-821-2781
  • Fax: 801-901-1194
Mailing address:
  • Phone: 801-821-2781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11267863-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: