Individual provider Active NPI

Lori D McEachern, PSYD

  • Clinical Psychologist
  • Provo, UT
National Provider Identifier
1609937168
Registry record updated Mar 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
10549595-2504 Issued in UT
Practice address
1300 E Center Street
Provo, UT 84606-3554
Phone
(801) 344-4400
NPI assigned
Dec 12, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 6, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 10549595-2504 UT Primary
Mental Health Counselor 101YM0800X 7402 MA

Addresses

Primary practice location

1300 E Center Street
Provo, UT 84606-3554

Mailing address

PO Box 270
Provo, UT 84603-0270
Phone (801) 344-4400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT, CT2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20190128000869 UT Practitioner - Clinical Psychologist 5991042046 Reassigns benefits to 1 organization
I20241023001585 CT Practitioner - Clinical Psychologist 5991042046 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
7402MAMDPsychologist
10549595-2504UTMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Northeast Neuropsychology, LLC CurrentSince Sep 1, 2024 Accepting new patients
State of Utah CurrentSince Nov 17, 2018 Accepting new patients
Advanced Telepsych PLLC PastSince Jan 1, 2024 Accepting new patients
Western New England Integrated Learning Center, LLC Past Accepting new patients

Locations

609 W Johnson Ave
Ste 104
Cheshire, CT 06410
Phone (203) 272-6007

1300 E Center St
Provo, UT 84606
Phone (801) 344-4215

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583452800000",
    "number": "1609937168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 270",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846030270",
            "telephone_number": "801-344-4400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 E CENTER STREET",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846063554",
            "telephone_number": "801-344-4400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCEACHERN",
        "first_name": "LORI",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-12",
        "last_updated": "2020-03-06",
        "certification_date": "2020-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "UT",
            "license": "10549595-2504",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MA",
            "license": "7402",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Provo, UT

Sources for this page

Verify at the official NPI Registry.