Healthcare Provider Details

I. General information

NPI: 1962369637
Provider Name (Legal Business Name): THE LIVING ROOM THERAPY AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9135 S MONROE PLAZA WAY STE C
SANDY UT
84070-2692
US

IV. Provider business mailing address

9135 S MONROE PLAZA WAY STE C
SANDY UT
84070-2692
US

V. Phone/Fax

Practice location:
  • Phone: 801-829-1543
  • Fax:
Mailing address:
  • Phone: 801-829-1543
  • 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: RYAN PETERSON
Title or Position: CLINICAL MENTAL HEALTH COUNSELOR
Credential: CMHC
Phone: 801-829-1543