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General NPI Number Information
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NPI Number | 1912411992
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Entity Type | Organization
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Legal Business Name | LIVE STRONG HOUSE LLC
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Dates
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Enumeration Date | 11/28/2017
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Last Update Date | 10/15/2019
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Provider Practice Location Address
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Address Line | 377 N. MARSHALL WAY SUITE 1B
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City | LAYTON
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State | UT
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Zip | 84041
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Country | US
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Telephone | 801-725-7451
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Fax |
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Provider Business Mailing Address
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Address Line | 377 N. MARSHALL WAY SUITE 1B
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City | LAYTON
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State | UT
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Zip | 84041-5530
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Country | US
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Telephone | 801-725-7451
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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 | MARK SPALDING
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Credential | LCSW
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Telephone | 801-725-7451
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 163WP0807X
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Taxonomy Name | Child & Adolescent Psychiatric/Mental Health Registered Nurse
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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