Healthcare Provider Details

I. General information

NPI: 1134066491
Provider Name (Legal Business Name): SOLACE THERAPY AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 N FALCON CT
IVINS UT
84738-6690
US

IV. Provider business mailing address

225 N FALCON CT
IVINS UT
84738-6690
US

V. Phone/Fax

Practice location:
  • Phone: 435-668-1469
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: JAISHA EVANS
Title or Position: LMFT
Credential:
Phone: 435-668-1469