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
—
—
323P00000X
Psychiatric Residential Treatment Facility
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
UT
Other
Enumeration date
04/07/2015
Last updated
04/07/2015
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