Healthcare Provider Details

I. General information

NPI: 1205779634
Provider Name (Legal Business Name): LIFE REFRAMED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2026
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1034 RSI DR STE 120
LOGAN UT
84321-2203
US

IV. Provider business mailing address

1034 RSI DR STE 120
LOGAN UT
84321-2203
US

V. Phone/Fax

Practice location:
  • Phone: 435-799-9812
  • Fax:
Mailing address:
  • Phone: 435-799-9812
  • Fax:

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: REBECCA MARTINEZ
Title or Position: OWNER / THERAPIST
Credential: LCSW
Phone: 435-799-9812