# TEARACE ENT., LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Your Life Launch
- **Organization subpart:** No

## Provider details

- **NPI number:** 1326504523
- **Authorized official:** MR. RANDY K SODERQUIST LCSW (OWNER)
- **Authorized official phone:** (435) 691-0856

## Contact information

- **Practice address:** 1739 S HIGHWAY 89A, KANAB, UT 84741-3957
- **Practice address phone:** (928) 643-6000
- **Practice address fax:** (928) 643-6024
- **Mailing address:** PO BOX 61, KANAB, UT 84741-0061
- **Mailing address phone:** (928) 643-6000
- **Mailing address fax:** (928) 643-6024

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM0855X | Adolescent and Children Mental Health Clinic/Center | — | NULL | Yes |
| 261QR0405X | Substance Use Disorder Rehabilitation Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 02/13/2019
- **Last updated:** 02/13/2019