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General NPI Number Information
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NPI Number | 1972206191
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Entity Type | Organization
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Legal Business Name | INTUITIVE LIFE BALANCE
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Dates
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Enumeration Date | 03/24/2023
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Last Update Date | 03/30/2023
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Provider Practice Location Address
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Address Line | 1404 W STATE RD
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City | PLEASANT GROVE
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State | UT
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Zip | 84062-5019
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Country | US
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Telephone | 385-265-2676
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Fax |
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Provider Business Mailing Address
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Address Line | 1404 W STATE RD STE 6
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City | PLEASANT GROVE
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State | UT
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Zip | 84062-5019
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Country | US
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Telephone | 385-265-2676
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | NOELLE GRAY
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Credential | LCSW
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Telephone | 801-915-7736
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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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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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