Organization
LIFE ENHANCEMENT CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHELLEY MANGUM ACMHC (ASS. CLINICAL MENTAL HEALTH COUNSEL)
(801) 796-0620
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
261QM0850X
Adult Mental Health Clinic/Center
Primary
5828209-6009
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
5828209-6009
UT
Other
Enumeration date
04/06/2012
Last updated
06/25/2012
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