Organization
MIND, BODY & SPIRIT COUNSELING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORRI K LAKE CMHC (OWNER)
(801) 520-3490
Entity
Organization
Contact information
Practice address
2180 E 4500 S STE 125, SALT LAKE CITY, UT 84117-4021
(801) 520-3490
Mailing address
2180 E 4500 S STE 125, SALT LAKE CITY, UT 84117-4021
(801) 520-3490
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
—
—
101YP2500X
Professional Counselor
—
—
Other
Enumeration date
04/29/2017
Last updated
05/01/2017
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