# IRON PHOENIX PSYCHIATRY, LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255055158
- **Authorized official:** JACOB CLARK (OWNER)
- **Authorized official phone:** (801) 449-1429

## Contact information

- **Practice address:** 138 E 12300 S UNIT 860, DRAPER, UT 84020-7976
- **Practice address phone:** (801) 449-1429
- **Mailing address:** 138 E 12300 S UNIT 860, DRAPER, UT 84020-7976

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 10/04/2022
- **Last updated:** 10/04/2022