Healthcare Provider Details

I. General information

NPI: 1275140089
Provider Name (Legal Business Name): LOVE & WELLNESS COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2020
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

628 N PUGSLEY ST
SALT LAKE CITY UT
84103-1329
US

IV. Provider business mailing address

628 N PUGSLEY ST
SALT LAKE CITY UT
84103-1329
US

V. Phone/Fax

Practice location:
  • Phone: 385-261-2171
  • Fax: 385-261-2827
Mailing address:
  • Phone: 385-261-2171
  • Fax: 385-261-2827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. SANDRA CHACON
Title or Position: MENTAL HEALTH COUNSELOR
Credential: LCSW
Phone: 801-991-0484