Healthcare Provider Details

I. General information

NPI: 1336890318
Provider Name (Legal Business Name): LONE PEAK PSYCHIATRY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2022
Last Update Date: 03/07/2022
Certification Date: 03/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

688 E VINE ST
MURRAY UT
84107-5549
US

IV. Provider business mailing address

688 E VINE ST
MURRAY UT
84107-5549
US

V. Phone/Fax

Practice location:
  • Phone: 801-436-6556
  • Fax: 833-921-2195
Mailing address:
  • Phone: 801-436-6556
  • Fax: 833-921-2195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA REED BENTLEY
Title or Position: OWNER
Credential: PMHNP
Phone: 801-436-6556