Organization
LIFE ENHANCEMENT CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RUSSELL C GAEDE PSYD (EXECUTIVE DIRECTOR)
(801) 623-4770
Entity
Organization
Contact information
Practice address
1835 N 1120 W, PROVO, UT 84604-1180
(801) 623-4770
(801) 623-4771
Mailing address
1835 N 1120 W, PROVO, UT 84604-1180
(801) 623-4770
(801) 623-4771
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
6332186-0142
UT
Other
Enumeration date
06/25/2008
Last updated
06/25/2008
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