MEDICARE: LIFETECH CONSULTING

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	7788192-6004	UT

General Provider Information

NPI Number	:	1720340623
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFETECH CONSULTING

Provider Business Mailing Address
First Line	:	1635 N 200 E
Second Line	:
City	:	NORTH LOGAN
State	:	UT
Zip	:	84341-1913
Country	:	US
Telephone Number	:	435-213-3687
Fax Number	:	435-753-7654

Provider Business Practice Location Address
First Line	:	1635 N 200 E
Second Line	:
City	:	NORTH LOGAN
State	:	UT
Zip	:	84341-1913
Country	:	US
Telephone Number	:	435-213-3687
Fax Number	:	435-753-7654

Authorized Official
Title or Position	:	OWNER
Name	:	MR. REX ALAN SPENDLOVE
Credential	:	MS, PC
Telephone Number	:	435-213-3687

Provider Enumeration Date	:	06/15/2012
Last Update Date	:	06/15/2012

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Directions to “LIFETECH CONSULTING ” Practice Location

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