Organization
LIFE STONE GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JULIE A. PETTIT (OWNER/PARTNER)
(801) 984-1717
Entity
Organization
Contact information
Practice address
613 E FORT UNION BLVD STE 104, MIDVALE, UT 84047
(801) 984-1717
(801) 984-1720
Mailing address
613 E FORT UNION BLVD STE 104, MIDVALE, UT 84047-5531
(801) 984-1717
(801) 984-1720
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
15893
UT
Other
Enumeration date
10/20/2009
Last updated
04/16/2019
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