Provider Demographics
NPI:1992073118
Name:NORTH, LINDSEY WYNONA (PHD)
Entity type:Individual
Prefix:DR
First Name:LINDSEY
Middle Name:WYNONA
Last Name:NORTH
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:PO BOX 95970
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-0970
Mailing Address - Country:US
Mailing Address - Phone:800-658-8556
Mailing Address - Fax:801-352-9502
Practice Address - Street 1:1477 N 2000 W
Practice Address - Street 2:SUITE E
Practice Address - City:CLINTON
Practice Address - State:UT
Practice Address - Zip Code:84015-8638
Practice Address - Country:US
Practice Address - Phone:801-614-5866
Practice Address - Fax:801-825-1162
Is Sole Proprietor?:No
Enumeration Date:2011-12-02
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
UT8977008-2501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program