Healthcare Provider Details

I. General information

NPI: 1861311615
Provider Name (Legal Business Name): LUCKY PATH THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4190 S HIGHLAND DR STE 116
MILLCREEK UT
84124-2668
US

IV. Provider business mailing address

435 N BISHOP PL
SALT LAKE CITY UT
84103-2179
US

V. Phone/Fax

Practice location:
  • Phone: 801-807-9294
  • Fax:
Mailing address:
  • Phone: 801-807-9294
  • 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: KELSEY CHRISTOPULOS
Title or Position: OWNER
Credential: LMFT
Phone: 801-807-9294