Organization
EVOLVING LIGHT COUNSELING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAUREY RAY CMBS (BILLING/CREDENTIALING)
(702) 279-7270
Entity
Organization
Contact information
Practice address
32 E 100 S STE 202, ST GEORGE, UT 84770-3495
(435) 668-4956
(702) 566-4575
Mailing address
32 E 100 S STE 202, ST GEORGE, UT 84770-3495
(435) 668-4956
(702) 566-4575
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
193400000X
—
UT
Enumeration date
04/07/2021
Last updated
04/07/2021
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