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General NPI Number Information
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NPI Number | 1386300549
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Entity Type | Organization
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Legal Business Name | RESILIENT LIFE COUNSELING, LLC
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Dates
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Enumeration Date | 11/11/2021
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Last Update Date | 11/11/2021
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Provider Practice Location Address
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Address Line | 1379 N 1075 W STE 228
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City | FARMINGTON
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State | UT
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Zip | 84025-2859
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Country | US
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Telephone | 385-316-7127
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Fax |
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Provider Business Mailing Address
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Address Line | 1379 N 1075 W STE 228
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City | FARMINGTON
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State | UT
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Zip | 84025-2859
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Country | US
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Telephone | 385-316-7127
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Fax |
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Authorized Official
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Title or Position | BUSINESS OWNER
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Name | MRS. RUTH ANGELA-PATINO HENDERSON
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Credential | LCSW
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Telephone | 385-316-7127
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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