Healthcare Provider Details

I. General information

NPI: 1629856547
Provider Name (Legal Business Name): HOPE AFTER HEALING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2023
Last Update Date: 09/20/2023
Certification Date: 09/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

961 W WILLOW GARDEN PASEO
FARMINGTON UT
84025-3874
US

IV. Provider business mailing address

961 W WILLOW GARDEN PASEO
FARMINGTON UT
84025-3874
US

V. Phone/Fax

Practice location:
  • Phone: 707-280-4448
  • Fax:
Mailing address:
  • Phone: 707-280-4448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LISA L WELLING
Title or Position: EXECUTIVE DIRECTOR
Credential: LCMHC
Phone: 707-280-4448