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Organization
LAKESIDE BILLING SERVICES
Active
Organization
LAKESIDE BILLING SERVICES
Active
Parent organization
ILLUME CENTER
Organization subpart
Yes
Provider details
NPI number
Legal business name
ILLUME CENTER
Authorized official
JOHANNA SALTER (OWNER)
(801) 755-4694
Entity
Organization
Contact information
Practice address
6280 W 9600 N, HIGHLAND, UT 84003-9234
(801) 703-7289
(801) 855-7207
Mailing address
6280 W 9600 N, HIGHLAND, UT 84003-9234
(801) 703-7289
(801) 855-7207
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
UT
101YP2500X
Professional Counselor
—
UT
103TA0400X
Addiction (Substance Use Disorder) Psychologist
—
UT
207QA0401X
Addiction Medicine (Family Medicine) Physician
—
NULL
207QA0401X
Addiction Medicine (Family Medicine) Physician
—
—
323P00000X
Psychiatric Residential Treatment Facility
—
NULL
324500000X
Substance Abuse Rehabilitation Facility
—
UT
Other
Enumeration date
04/07/2015
Last updated
04/07/2015
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