MEDICARE: SL PSYCHOLOGY, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1386487791
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SL PSYCHOLOGY, PLLC

Provider Business Mailing Address
First Line	:	1371 E 2100 S STE 102
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-3731
Country	:	US
Telephone Number	:	385-707-1193
Fax Number	:

Provider Business Practice Location Address
First Line	:	1371 E 2100 S STE 102
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-3731
Country	:	US
Telephone Number	:	385-707-1193
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. LAUREN MASUDA
Credential	:	PSYD, ABPP
Telephone Number	:	385-707-1193

Provider Enumeration Date	:	06/13/2024
Last Update Date	:	06/13/2024

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