Healthcare Provider Details

I. General information

NPI: 1053289579
Provider Name (Legal Business Name): HEAL AND RISE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2025
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1458 E 820 N
OREM UT
84097-5481
US

IV. Provider business mailing address

898 SOUTH STATE ST, STE 310 #5710
OREM UT
84097
US

V. Phone/Fax

Practice location:
  • Phone: 385-325-2624
  • Fax:
Mailing address:
  • Phone: 385-325-2624
  • 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: EDWARD SHIN
Title or Position: OWNER
Credential: LMFT
Phone: 385-325-2624