MEDICARE: SOLASTA HEALING CENTER

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1730778234
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOLASTA HEALING CENTER

Provider Business Mailing Address
First Line	:	10082 N OAK RD W
Second Line	:
City	:	CEDAR HILLS
State	:	UT
Zip	:	84062-9007
Country	:	US
Telephone Number	:	385-250-7478
Fax Number	:

Provider Business Practice Location Address
First Line	:	1404 W STATE RD STE 209
Second Line	:
City	:	PLEASANT GROVE
State	:	UT
Zip	:	84062-5041
Country	:	US
Telephone Number	:	385-250-7478
Fax Number	:

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	KRISTIN TUDSANDOS
Credential	:
Telephone Number	:	385-250-7478

Provider Enumeration Date	:	01/11/2021
Last Update Date	:	01/11/2021

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Directions to “SOLASTA HEALING CENTER ” Practice Location

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