Provider Demographics
NPI:1023564051
Name:CRESSALL, LANCE
Entity Type:Individual
Prefix:
First Name:LANCE
Middle Name:
Last Name:CRESSALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7250 BALMER ST BLDG 533
Mailing Address - Street 2:
Mailing Address - City:HILL AIR FORCE BASE
Mailing Address - State:UT
Mailing Address - Zip Code:84056-5009
Mailing Address - Country:US
Mailing Address - Phone:801-777-7909
Mailing Address - Fax:
Practice Address - Street 1:7321 BALMER ST BLDG 545
Practice Address - Street 2:
Practice Address - City:HILL AIR FORCE BASE
Practice Address - State:UT
Practice Address - Zip Code:84056-5012
Practice Address - Country:US
Practice Address - Phone:801-777-7909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-30
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10859794-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical