Organization
PURE LIFE PTG
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN LUND (EXECUTIVE DIRECTOR)
(801) 664-3741
Entity
Organization
Contact information
Practice address
7390 S CREEK RD STE 202, SANDY, UT 84093-6123
(801) 893-2550
Mailing address
14218 S CANYON VINE CV, DRAPER, UT 84020-5631
(801) 878-9597
Taxonomy
Speciality
Code
Description
License number
State
103TA0400X
Addiction (Substance Use Disorder) Psychologist
Primary
—
—
Other
Enumeration date
01/03/2018
Last updated
01/03/2018
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