Healthcare Provider Details

I. General information

NPI: 1831030147
Provider Name (Legal Business Name): LIFESTYLE MENTAL HEALTH, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 W 2230 N STE 225
PROVO UT
84604-6709
US

IV. Provider business mailing address

333 W 2230 N STE 225
PROVO UT
84604-6709
US

V. Phone/Fax

Practice location:
  • Phone: 385-230-7799
  • Fax:
Mailing address:
  • Phone: 385-230-7799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ALEX MAGENO
Title or Position: OWNER
Credential: MD
Phone: 385-230-7799