Healthcare Provider Details

I. General information

NPI: 1194392670
Provider Name (Legal Business Name): LIFE BALANCE RECOVERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2021
Last Update Date: 06/04/2021
Certification Date: 06/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1291 EXPRESSWAY LN
SPANISH FORK UT
84660-1333
US

IV. Provider business mailing address

1291 EXPRESSWAY LN
SPANISH FORK UT
84660-1333
US

V. Phone/Fax

Practice location:
  • Phone: 801-367-0394
  • Fax:
Mailing address:
  • Phone: 801-367-0394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHELSIE LAURIE DURDEN
Title or Position: OWNER
Credential:
Phone: 801-367-0394