Healthcare Provider Details

I. General information

NPI: 1023534013
Provider Name (Legal Business Name): I AM RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2017
Last Update Date: 06/17/2021
Certification Date: 06/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 E STATE ST
LEHI UT
84043-1625
US

IV. Provider business mailing address

PO BOX 1061
LEHI UT
84043-1198
US

V. Phone/Fax

Practice location:
  • Phone: 801-407-9998
  • Fax: 801-797-1223
Mailing address:
  • Phone: 801-407-9998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0800X
TaxonomyRecovery Care Clinic/Center
License Number6019771-3902
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number6019771-3902
License Number StateUT

VIII. Authorized Official

Name: JARED MORONI CASEY
Title or Position: CEO
Credential: LMFT
Phone: 801-407-9998