Healthcare Provider Details

I. General information

NPI: 1407515760
Provider Name (Legal Business Name): LIFE LAUNCH CENTERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2021
Last Update Date: 12/14/2021
Certification Date: 07/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 N 1680 E STE J1
ST GEORGE UT
84790-2588
US

IV. Provider business mailing address

230 N 1680 E STE J1
ST GEORGE UT
84790-2588
US

V. Phone/Fax

Practice location:
  • Phone: 435-767-0552
  • Fax: 435-767-0278
Mailing address:
  • Phone: 435-767-0552
  • Fax: 435-767-0278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JONI DYCHES
Title or Position: FINANCIAL DIR
Credential:
Phone: 801-803-8240