MEDICARE: LIVE STRONG HOUSE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	261QM0850X	Adult Mental Health Clinic/Center
3	3245S0500X	Children's Substance Abuse Rehabilitation Facility
4	163WP0807X	Child & Adolescent Psychiatric/Mental Health Registered Nurse
5	101YA0400X	Addiction (Substance Use Disorder) Counselor
6	261QM0855X	Adolescent and Children Mental Health Clinic/Center
7	323P00000X	Psychiatric Residential Treatment Facility

General Provider Information

NPI Number	:	1912411992
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIVE STRONG HOUSE LLC

Provider Business Mailing Address
First Line	:	2276 W 2700 S
Second Line	:
City	:	SYRACUSE
State	:	UT
Zip	:	84075-9001
Country	:	US
Telephone Number	:	801-725-7451
Fax Number	:

Provider Business Practice Location Address
First Line	:	2276 W 2700 S
Second Line	:
City	:	SYRACUSE
State	:	UT
Zip	:	84075
Country	:	US
Telephone Number	:	801-725-7451
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	MARK SPALDING
Credential	:	LCSW
Telephone Number	:	801-725-7451

Provider Enumeration Date	:	11/28/2017
Last Update Date	:	04/01/2026

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Directions to “LIVE STRONG HOUSE LLC ” Practice Location

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