Organization
CHANGES FOR LIFE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARCIE D GRAY LSUDC (OWNER/OPERATOR)
(435) 218-2414
Entity
Organization
Contact information
Practice address
1086 S MAIN ST, SUITE #2, ST GEORGE, UT 84770-5277
(435) 218-2414
Mailing address
1086 S MAIN ST, SUITE #2, ST GEORGE, UT 84770-5277
(435) 218-2414
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
6656303-6006
UT
1041C0700X
Clinical Social Worker
266415-3501
UT
Other
Enumeration date
07/14/2015
Last updated
05/16/2016
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