Healthcare Provider Details

I. General information

NPI: 1639958812
Provider Name (Legal Business Name): ABUNDANT LIFE INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2023
Last Update Date: 11/21/2023
Certification Date: 11/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

277 E 950 S
OREM UT
84058-5004
US

IV. Provider business mailing address

277 E 950 S
OREM UT
84058-5004
US

V. Phone/Fax

Practice location:
  • Phone: 801-427-0301
  • Fax:
Mailing address:
  • Phone: 801-427-0301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. FRANCISCO XAVIER AMPUERO
Title or Position: CLINICAL DIRECTOR
Credential: LCSW
Phone: 801-427-0301