Healthcare Provider Details

I. General information

NPI: 1326770165
Provider Name (Legal Business Name): ZEST FOR LIFE COUNSELING - HOLLADAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

2046 E MURRAY HOLLADAY RD STE 101
HOLLADAY UT
84117-5173
US

IV. Provider business mailing address

2046 E MURRAY HOLLADAY RD STE 101
HOLLADAY UT
84117-5173
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 TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

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