Healthcare Provider Details

I. General information

NPI: 1467603753
Provider Name (Legal Business Name): LIVE STRONG COUNSELING AND HEALTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2008
Last Update Date: 10/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1747 HERITAGE LN
SYRACUSE UT
84075-8552
US

IV. Provider business mailing address

2289 W 2200 S
SYRACUSE UT
84075-9286
US

V. Phone/Fax

Practice location:
  • Phone: 801-726-2528
  • Fax:
Mailing address:
  • Phone: 801-726-2528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3371293502
License Number StateUT

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MRS. AMY K SPALDING
Title or Position: OWNER
Credential:
Phone: 801-726-2528