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General NPI Number Information
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NPI Number | 1902044472
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Entity Type | Organization
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Legal Business Name | LIFESTAR
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Dates
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Enumeration Date | 01/21/2009
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 151 E 5600 S STE 204
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City | MURRAY
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State | UT
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Zip | 84107-8146
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Country | US
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Telephone | 801-262-2400
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Fax |
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Provider Business Mailing Address
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Address Line | 151 E 5600 S STE 204
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City | MURRAY
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State | UT
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Zip | 84107-8146
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Country | US
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Telephone | 801-262-2400
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | MR. TODD OLSON
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Credential | CSAT, LCSW
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Telephone | 801-262-7409
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State | UT
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