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General NPI Number Information
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NPI Number | 1639958812
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Entity Type | Organization
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Legal Business Name | ABUNDANT LIFE INSTITUTE
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Dates
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Enumeration Date | 09/26/2023
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Last Update Date | 11/21/2023
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Provider Practice Location Address
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Address Line | 277 E 950 S
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City | OREM
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State | UT
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Zip | 84058-5004
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Country | US
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Telephone | 801-427-0301
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Fax |
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Provider Business Mailing Address
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Address Line | 277 E 950 S
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City | OREM
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State | UT
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Zip | 84058-5004
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Country | US
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Telephone | 801-427-0301
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MR. FRANCISCO XAVIER AMPUERO
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Credential | LCSW
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Telephone | 801-427-0301
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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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