Provider Demographics
NPI:1841022795
Name:CANYON RIDGE PSYCHOLOGY LLC
Entity type:Organization
Organization Name:CANYON RIDGE PSYCHOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:LEFRANDT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:801-252-5122
Mailing Address - Street 1:455 N UNIVERSITY AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84601-2867
Mailing Address - Country:US
Mailing Address - Phone:801-252-5122
Mailing Address - Fax:
Practice Address - Street 1:455 N UNIVERSITY AVE STE 201
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84601-2867
Practice Address - Country:US
Practice Address - Phone:801-252-5122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty