MEDICARE: LIFE LAUNCH CENTERS OF SOUTH SALT LAKE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	101YM0800X	Mental Health Counselor
3	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1336705292
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE LAUNCH CENTERS OF SOUTH SALT LAKE

Provider Business Mailing Address
First Line	:	230 N 1680 E STE J1
Second Line	:
City	:	ST GEORGE
State	:	UT
Zip	:	84790-2588
Country	:	US
Telephone Number	:	435-767-0552
Fax Number	:	435-767-0278

Provider Business Practice Location Address
First Line	:	9289 S REDWOOD RD STE D&E
Second Line	:
City	:	WEST JORDAN
State	:	UT
Zip	:	84088-6730
Country	:	US
Telephone Number	:	833-803-3883
Fax Number	:	435-767-0278

Authorized Official
Title or Position	:	OWNER/CFO
Name	:	JONI L DYCHES
Credential	:
Telephone Number	:	801-803-8240

Provider Enumeration Date	:	05/16/2019
Last Update Date	:	04/28/2025

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Directions to “LIFE LAUNCH CENTERS OF SOUTH SALT LAKE ” Practice Location

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