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NPI Code Detail

MEDICARE: LONE PEAK PSYCHOLOGICAL EVALUATIONS, INC

MEDICARE: LONE PEAK PSYCHOLOGICAL EVALUATIONS, INC
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
1103TC0700XClinical Psychologist

General Provider Information

NPI Number : 1518807551
Entity Type Code : Organization
Provider Name (Legal Business Name) : LONE PEAK PSYCHOLOGICAL EVALUATIONS, INC
Provider Business Mailing Address
First Line : 6787 S REDWOOD RD STE 2
Second Line :
City : WEST JORDAN
State : UT
Zip : 84084-2404
Country : US
Telephone Number : 801-203-4442
Fax Number :
Provider Business Practice Location Address
First Line : 6787 S REDWOOD RD STE 2
Second Line :
City : WEST JORDAN
State : UT
Zip : 84084-2404
Country : US
Telephone Number : 801-203-4442
Fax Number :
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : CASEY MANGNALL
Credential : PSYD
Telephone Number : 801-203-4442
Provider Enumeration Date : 03/30/2026
Last Update Date : 03/30/2026

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