Provider Demographics
NPI:1346226420
Name:MCGILL, LIZABETH A (PHD)
Entity Type:Individual
Prefix:DR
First Name:LIZABETH
Middle Name:A
Last Name:MCGILL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1141 E 3900 S
Mailing Address - Street 2:A125
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1215
Mailing Address - Country:US
Mailing Address - Phone:801-264-2300
Mailing Address - Fax:801-264-2328
Practice Address - Street 1:1141 E 3900 S
Practice Address - Street 2:A125
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1215
Practice Address - Country:US
Practice Address - Phone:801-264-2300
Practice Address - Fax:801-264-2328
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1111562501103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTR61204Medicare UPIN
UT004662006Medicare PIN
UT004662189Medicare PIN