Healthcare Provider Details

I. General information

NPI: 1609937168
Provider Name (Legal Business Name): LORI D MCEACHERN PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 03/06/2020
Certification Date: 03/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 E CENTER STREET
PROVO UT
84606-3554
US

IV. Provider business mailing address

PO BOX 270
PROVO UT
84603-0270
US

V. Phone/Fax

Practice location:
  • Phone: 801-344-4400
  • Fax:
Mailing address:
  • Phone: 801-344-4400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7402
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number10549595-2504
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: