Life Elevated Psychiatry LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

LIFE ELEVATED PSYCHIATRY LLC

Practice address

11620 S State St Ste 1403
Draper, UT 84020-7124

Phone

(385) 302-7369

Fax

(385) 247-8023

NPI assigned

Jun 29, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Brock Haskell, PA-CNPI 1821627746

Title

Owner

Phone

(385) 302-7369

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Brock Haskell

  • Physician Assistant
  • Draper, UT
  • NPI 1821627746
  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1687996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687996800000",
    "number": "1063199305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11620 S STATE ST STE 1403",
            "city": "DRAPER",
            "state": "UT",
            "postal_code": "840207124",
            "telephone_number": "385-302-7369",
            "fax_number": "385-247-8023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11620 S STATE ST STE 1403",
            "city": "DRAPER",
            "state": "UT",
            "postal_code": "840207124",
            "telephone_number": "385-302-7369",
            "fax_number": "385-247-8023"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE ELEVATED PSYCHIATRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-29",
        "last_updated": "2023-06-29",
        "certification_date": "2023-06-29",
        "status": "A",
        "authorized_official_last_name": "HASKELL",
        "authorized_official_first_name": "BROCK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "385-302-7369",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brian Glenn Lewis, CMHC
• Canyon Lewis
• Jason Richard Lewis, D.D.S.
• McKay Arthur Lewis, DDS
• Qing Li
• Life Elevated Therapy & Coaching, PLLC
• Life Health DME, LLC
• Lifetime Products Inc.
• Lighten Home Health and Hospice
• Lighten Hospice

• Mental Health Clinic/Center (Including Community Mental Health Center) in Draper, UT
• Providers in Draper, UT by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.