Healthcare Provider Details

I. General information

NPI: 1023922630
Provider Name (Legal Business Name): CHANGING LIVES COUNSELING ALLEN MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9055 S 1300 E
SANDY UT
84094-3133
US

IV. Provider business mailing address

1213 W SADDLE BLUFF DR
MURRAY UT
84123-2912
US

V. Phone/Fax

Practice location:
  • Phone: 801-332-9838
  • Fax:
Mailing address:
  • Phone: 505-463-5598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TIMOTHY WITH ALLEN
Title or Position: COUNSELOR
Credential: CMHC
Phone: 801-332-9838