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General NPI Number Information
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NPI Number | 1336890318
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Entity Type | Organization
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Legal Business Name | LONE PEAK PSYCHIATRY, LLC
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Dates
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Enumeration Date | 01/12/2022
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Last Update Date | 03/07/2022
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Provider Practice Location Address
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Address Line | 688 E VINE ST
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City | MURRAY
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State | UT
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Zip | 84107-5549
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Country | US
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Telephone | 801-436-6556
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Fax | 833-921-2195
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Provider Business Mailing Address
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Address Line | 688 E VINE ST
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City | MURRAY
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State | UT
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Zip | 84107-5549
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Country | US
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Telephone | 801-436-6556
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Fax | 833-921-2195
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Authorized Official
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Title or Position | OWNER
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Name | JOSHUA REED BENTLEY
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Credential | PMHNP
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Telephone | 801-436-6556
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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