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General NPI Number Information
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NPI Number | 1538029202
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Entity Type | Organization
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Legal Business Name | LAVENDER AND LIGHT COLLECTIVE, PLLC
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Dates
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Enumeration Date | 11/14/2025
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Last Update Date | 11/14/2025
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Provider Practice Location Address
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Address Line | 5094 E BIG SKY WAY
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City | EAGLE MOUNTAIN
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State | UT
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Zip | 84005-4878
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Country | US
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Telephone | 435-610-1676
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Fax |
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Provider Business Mailing Address
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Address Line | 5094 E BIG SKY WAY
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City | EAGLE MOUNTAIN
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State | UT
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Zip | 84005-4878
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Country | US
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Telephone | 435-610-1676
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Fax |
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Authorized Official
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Title or Position | OWNER/ MEMBER
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Name | MADISEN ELISE BUSENBARK
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Credential |
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Telephone | 435-610-1676
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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