Organization
LIFESTAR SALT LAKE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DANIEL D GRAY LCSW, CSAT (CLINICAL DIRECTOR)
(801) 262-2400
Entity
Organization
Contact information
Practice address
151 E 5600 S, #204, MURRAY, UT 84107-6181
(801) 262-2400
(801) 262-9991
Mailing address
151 E 5600 S, #204, MURRAY, UT 84107-6181
(801) 262-2400
(801) 262-9991
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
123039-3501
UT
Other
Enumeration date
01/28/2013
Last updated
01/28/2013
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