Healthcare Provider Details

I. General information

NPI: 1073152021
Provider Name (Legal Business Name): IGNITING CHANGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2019
Last Update Date: 12/21/2019
Certification Date: 12/21/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

179 N 1200 E STE 101
LEHI UT
84043-2148
US

IV. Provider business mailing address

179 N 1200 E STE 101
LEHI UT
84043-2148
US

V. Phone/Fax

Practice location:
  • Phone: 801-806-4878
  • Fax: 877-695-7720
Mailing address:
  • Phone: 801-806-4878
  • Fax: 877-695-7720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. TORREY HARMON
Title or Position: OWNER/THERAPIST
Credential: CMHC
Phone: 801-376-3664