Healthcare Provider Details

I. General information

NPI: 1245911205
Provider Name (Legal Business Name): FAITH ELENA BYRD LSUDC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2023
Last Update Date: 01/02/2026
Certification Date: 01/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6671 S REDWOOD RD STE 201
WEST JORDAN UT
84084-7491
US

IV. Provider business mailing address

6671 S REDWOOD RD STE 201
WEST JORDAN UT
84084-7491
US

V. Phone/Fax

Practice location:
  • Phone: 831-212-0739
  • Fax:
Mailing address:
  • Phone: 831-212-0739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number14233784-6006
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: