Healthcare Provider Details

I. General information

NPI: 1063325140
Provider Name (Legal Business Name): FROSTED MAGIC MIND AND BODY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 E SOUTH UNION AVE
MIDVALE UT
84047-2904
US

IV. Provider business mailing address

1100 E SOUTH UNION AVE
MIDVALE UT
84047-2904
US

V. Phone/Fax

Practice location:
  • Phone: 385-437-0789
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: TREASURE LILY LUNDSKOG
Title or Position: OWNER
Credential: LCSW
Phone: 801-935-5715