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General NPI Number Information
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NPI Number | 1184970642
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Entity Type | Individual
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Provider Name | LISA L ANSEL PH.D.
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Gender | Female
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Dates
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Enumeration Date | 08/01/2012
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Last Update Date | 06/02/2025
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Provider Practice Location Address
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Address Line | 7533 S CENTER VIEW CT STE R
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City | WEST JORDAN
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State | UT
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Zip | 84084-5526
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Country | US
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Telephone | 228-200-1100
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Fax | 228-200-1097
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Provider Business Mailing Address
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Address Line | 879 E 1510 N
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City | NORTH OGDEN
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State | UT
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Zip | 84404-7770
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Country | US
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Telephone | 228-200-1100
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Fax | 228-200-1097
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 53926
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 53926
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License Number State | MS
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 8073852-2501
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License Number State | UT
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