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Organization

LIFE ELEVATED PSYCHIATRY LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
BROCK HASKELL PA-C (OWNER)
(385) 302-7369
Entity
Organization

Contact information

Practice address
11620 S STATE ST STE 1403, DRAPER, UT 84020-7124
(385) 302-7369
(385) 247-8023
Mailing address
11620 S STATE ST STE 1403, DRAPER, UT 84020-7124
(385) 302-7369
(385) 247-8023

Taxonomy

Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary

Other

Enumeration date
06/29/2023
Last updated
06/29/2023
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