Healthcare Provider Details

I. General information

NPI: 1417659186
Provider Name (Legal Business Name): UTAH CENTER FOR PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6787 S REDWOOD RD
WEST JORDAN UT
84084-2404
US

IV. Provider business mailing address

14 W STATE ST # 84758
ORDERVILLE UT
84758-8001
US

V. Phone/Fax

Practice location:
  • Phone: 801-839-5360
  • Fax: 801-683-6672
Mailing address:
  • Phone: 801-839-5360
  • Fax: 801-683-6672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CASEY MANGNALL
Title or Position: LICENSED PSYCHOLOGIST
Credential: PSYD
Phone: 801-839-5360