Organization
ILLUMINATE AND EVOLVE THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MONA LISA CHAVEZ ESQUEDA MSW, LCSW, PH.D(ABD) (OWNER/OPERATOR)
(801) 633-6579
Entity
Organization
Contact information
Practice address
3435 S BROOK VIEW LN, SALT LAKE CITY, UT 84106-1593
(801) 633-6579
Mailing address
3435 S BROOK VIEW LN, SALT LAKE CITY, UT 84106-1593
(801) 633-6579
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
12/11/2021
Last updated
12/11/2021
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