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Organization
THERAPEUTIC LIFESTYLE CENTER OF UTAH
Active
Organization
THERAPEUTIC LIFESTYLE CENTER OF UTAH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SASHA KIHM (ADMINISTRATIVE DIRECTOR)
(801) 691-7064
Entity
Organization
Contact information
Practice address
1151 E 3900 S STE B175, SALT LAKE CITY, UT 84124-1255
(801) 691-7064
Mailing address
1151 E 3900 S STE B175, SALT LAKE CITY, UT 84124-1255
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
NULL
101YM0800X
Mental Health Counselor
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
12/07/2018
Last updated
12/07/2018
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