MEDICARE: INTERMOUNTAIN MENTAL HEALTH, 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
1	103T00000X	Psychologist	2774677-2501	UT

General Provider Information

NPI Number	:	1588847008
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERMOUNTAIN MENTAL HEALTH, INC.

Provider Business Mailing Address
First Line	:	PO BOX 57885
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84157-0885
Country	:	US
Telephone Number	:	801-673-4841
Fax Number	:

Provider Business Practice Location Address
First Line	:	5012 S TIMBER WAY UNIT 206
Second Line	:
City	:	MILLCREEK
State	:	UT
Zip	:	84117-5875
Country	:	US
Telephone Number	:	801-673-4841
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MORRIS N. LEWIS JR.
Credential	:	PHD
Telephone Number	:	801-673-4841

Provider Enumeration Date	:	12/06/2007
Last Update Date	:	01/22/2021

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