Healthcare Provider Details

I. General information

NPI: 1396573440
Provider Name (Legal Business Name): ZEST FOR LIFE COUNSELING - ST GEORGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2024
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

491 E RIVERSIDE DR STE 3A
ST GEORGE UT
84790-7056
US

IV. Provider business mailing address

556 E 300 S STE 101
AMERICAN FORK UT
84003-3844
US

V. Phone/Fax

Practice location:
  • Phone: 801-980-2566
  • Fax: 801-610-2017
Mailing address:
  • Phone: 801-980-2566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD JOSEPH HYDO IV
Title or Position: MANAGING PARTNER
Credential: DSW
Phone: 801-433-8149