Organization
TMS ELEVATED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA LOPEZ-LARSON MD (OWNER/PROVIDER)
(385) 441-3004
Entity
Organization
Contact information
Practice address
1790 SUN PEAK DR STE B105, PARK CITY, UT 84098-6625
(385) 441-3004
(435) 602-1131
Mailing address
1790 SUN PEAK DR STE B105, PARK CITY, UT 84098-6625
(385) 441-3004
(435) 602-1131
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
—
—
Other
Enumeration date
07/14/2020
Last updated
07/14/2020
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