Individual
CASEY MANGNALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
1300 E CENTER ST, PROVO, UT 84606-3554
(801) 344-4400
Mailing address
1300 E CENTER ST, PROVO, UT 84606-3554
(801) 344-4400
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
103TC0700X
Clinical Psychologist
12377684-2504
UT
103TF0200X
Forensic Psychologist
12377684-2504
UT
Other
Enumeration date
09/29/2016
Last updated
11/05/2021
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