Healthcare Provider Details

I. General information

NPI: 1952838435
Provider Name (Legal Business Name): ZEST FOR LIFE COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2017
Last Update Date: 06/29/2022
Certification Date: 06/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

556 E 300 S STE 108
AMERICAN FORK UT
84003-3844
US

IV. Provider business mailing address

556 E 300 S STE 108
AMERICAN FORK UT
84003-3844
US

V. Phone/Fax

Practice location:
  • Phone: 801-980-2566
  • Fax: 801-610-2017
Mailing address:
  • Phone: 801-980-2566
  • Fax: 801-610-2017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6255312-3501
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD HYDO
Title or Position: EXECUTIVE DIRECTOR
Credential: DSW, LCSW
Phone: 801-980-2566