# LAKESIDE BILLING SERVICES

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Parent organization:** ILLUME CENTER
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1033505011
- **Legal business name:** ILLUME CENTER
- **Authorized official:** JOHANNA SALTER (OWNER)
- **Authorized official phone:** (801) 755-4694

## Contact information

- **Practice address:** 6280 W 9600 N, HIGHLAND, UT 84003-9234
- **Practice address phone:** (801) 703-7289
- **Practice address fax:** (801) 855-7207
- **Mailing address:** 6280 W 9600 N, HIGHLAND, UT 84003-9234
- **Mailing address phone:** (801) 703-7289
- **Mailing address fax:** (801) 855-7207

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | UT | Yes |
| 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