LIFE INTEGRATIVE HEALTH CENTER (NPI# 1063833721) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063833721 |
| Entity Type | Organization |
| Organization Name | LIFE INTEGRATIVE HEALTH CENTER |
| Other Organization Name | THETA WELLNESS CENTER - PROVO |
| Practice Address |
777 N 500 W Suite 104 Provo UT 84601-1541 |
| Mailing Address |
777 N 500 W Ste 104 Provo UT 84601-1541 |
| Practice Telephone | 8018698199 |
| Practice Fax Number | 8017050436 |
| Mailing Telephone | 8018698199 |
| Mailing Fax Number | 8017050436 |
| Enumeration Date | 2013-12-26 |
| Last Update Date | 2014-04-09 |
| Authorized Official Name | MRS. KENDRA BERNAL (CLINICAL ADMINISTRATOR) |
| Authorized Official Telephone | 8018698199 |
| Authorized Official Credential | MA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QM0850X |
Clinic/Center Specialization: Adult Mental Health |
00000000000 | UT | Ambulatory Health Care Facilities |
| N | 261QH0100X |
Clinic/Center Specialization: Health Service |
0000000 | UT | Ambulatory Health Care Facilities |
| N | 261QH0100X |
Clinic/Center Specialization: Health Service |
NOT REQUIRED | UT | Ambulatory Health Care Facilities |
| N | 261QM0850X |
Clinic/Center Specialization: Adult Mental Health |
NOT REQUIRED | UT | Ambulatory Health Care Facilities |
| N | 261QM0855X |
Clinic/Center Specialization: Adolescent and Children Mental Health |
NOT REQUIRED | UT | Ambulatory Health Care Facilities |
| Y | 261Q00000X | Clinic/Center | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Theta Wellness Center - Provo | Former Legal Business Name - Organization |
| Street Address |
777 N 500 W SUITE 104 |
| City | PROVO |
| State | UT |
| Zip Code | 84601-1541 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699746529 | Jeffrey A Youngquist | Dentist | 777 N 500 W, Suite #201-a, Provo, UT 84601-1541 | 2006-01-30 |
| 1205288586 | Lyndi Jenson | Dentist | 777 N 500 W, Provo, UT 84601-1541 | 2016-07-11 |
| 1922474956 | Rock Canyon Dentistry | Dentist | 777 N 500 W, #105, Provo, UT 84601-1541 | 2015-08-13 |
| 1700295227 | All Around Dental Care, Lc | Dentist | 777 N 500 W, Ste 106, Provo, UT 84601-1541 | 2014-08-08 |
| 1164846044 | Kyle Kone | Marriage & Family Therapist | 777 N 500 W, #104, Provo, UT 84601-1541 | 2014-02-12 |
| 1376985721 | Canyon View Medical Group LLC | Obstetrics & Gynecology | 777 N 500 W, Suite 203, Provo, UT 84601 | 2013-07-26 |
| 1306186952 | Edison Stanford Hearing Aid Center | Hearing Aid Equipment | 777 N 500 W, Suite 005, Provo, UT 84601-1541 | 2013-02-19 |
| 1861755571 | Devin Lynn Davidson | Dentist | 777 N 500 W, Suite 106, Provo, UT 84601-1541 | 2012-06-18 |
| 1932473188 | All Around Dental Care | Dentist | 777 N 500 W, 106, Provo, UT 84601-1541 | 2012-03-06 |
| 1942503214 | Charles Christopher Lloyd | Hearing Instrument Specialist | 777 N 500 W, Suite #005, Provo, UT 84601-1541 | 2010-12-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902378417 | 1 Assist Care of Utah Valley LLC | In Home Supportive Care | 180 N University Avenue, Suite 270, Office 213, Provo, UT 84601 | 2018-12-21 |
| 1346723319 | Mp Dental LLC | Dentist | 777 N. 500 W. #204, Proud, UT 84601 | 2018-09-14 |
| 1326530601 | Madison Paige Nelson | Case Manager/Care Coordinator | 750 N Freedom Blvd., Provo, UT 84601 | 2018-06-03 |
| 1245758861 | Annette Roylance | Case Manager/Care Coordinator | 750 North Freedom Boulevard, Suite 300, Provo, UT 84601 | 2017-09-04 |
| 1912422205 | Alexandra Mcbride | Specialist/Technologist | 35 N 300 W #440, Provo, UT 84601 | 2017-08-07 |
| 1932638293 | Audrey Clara Clifton | Case Manager/Care Coordinator | 750 North Freedom Blvd., Provo, UT 84601 | 2017-06-08 |
| 1528514197 | Joseph Hyrum Lewis | Case Manager/Care Coordinator | 750 Freedom Blvd, Provo, UT 84601 | 2016-09-01 |
| 1629427620 | Walker Clements | Case Manager/Care Coordinator | 750 North Freedom Blvd, Provo, UT 84601 | 2016-06-09 |
| 1447611595 | Robert Shirley | Student in an Organized Health Care Education/Training Program | 750 North 200 West, Provo, Ut 84601., Provo, UT 84601 | 2016-03-17 |
| 1700286283 | Brelynn Downs | Student in an Organized Health Care Education/Training Program | 750 North Freedom Blvde, Provo, UT 84601 | 2014-09-03 |
| Find all providers in zip 84601 | ||||
| Taxonomy Code | 261Q00000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407359078 | Ihc Health Services Inc | Clinic/Center | 380 W Bulldog Blvd, Ste 403, Provo, UT 84604 | 2018-03-09 |
| 1992212641 | Ideal Option, Pllc | Clinic/Center | 2230 N University Pkwy Ste 5, Provo, UT 84604-4743 | 2018-01-03 |
| 1205232923 | Nahuel Image Center | Clinic/Center | 1700 N State St, Suite 16, Provo, UT 84604-1011 | 2014-11-06 |
| 1245648468 | Richard W. Parkinson | Clinic/Center | 5314 N 250 W Ste 220, Provo, UT 84604-7746 | 2014-07-31 |
| 1912137084 | Dennis W. Remington M.d.,p.c. | Clinic/Center | 1675 N Freedom Blvd Ste 11e, Provo, UT 84604-6936 | 2009-07-22 |
| 1760677686 | Evan J Matheson | Clinic/Center | 745 N 500 W # 200, Provo, UT 84601-1472 | 2007-09-13 |
| 1417299827 | Northern Utah Center for Couples and Families, Pllc | Clinic/Center | 3507 N University Ave, Ste 350, Provo, UT 84604-4478 | 2013-03-23 |
| 1538452826 | Glasgow Chiropractic and Rehabilitation P.l.l.c | Clinic/Center | 2230 N University Pkwy, #6b, Provo, UT 84604-1509 | 2011-05-19 |
| 1578759114 | Hugo G. Altamirano Md LLC | Clinic/Center | 745 N 500 W # 200, Provo, UT 84601-1472 | 2007-09-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083226237 | Utah Wellness Solutions | Clinic/Center | 1664 W Towne Center Dr Ste D, South Jordan, UT 84095-8612 | 2020-08-19 |
| 1376166561 | Nuna Munay | Clinic/Center | 9525 S Tramway Dr, Sandy, UT 84092-3108 | 2020-05-21 |
| 1679193338 | Uintah Basin Medical Center | Clinic/Center | 50 S 200 E, Duchesne, UT 84021 | 2020-04-23 |
| 1225658800 | Provider Services Network, Inc. | Clinic/Center | 765 E 340 S Ste 206, American Fork, UT 84003-3310 | 2020-04-23 |
| 1578100186 | 124 South Fairfield LLC | Clinic/Center | 124 S Fairfield Rd Ste B, Layton, UT 84041-7106 | 2019-12-02 |
| 1710468384 | Skull Valley Health Clinic | Clinic/Center | 1929 Aaron Dr Ste I, Tooele, UT 84074-8112 | 2018-08-22 |
| 1275021784 | Axis Chiropractic and Massage Clinic, LLC | Clinic/Center | 1681 W 3860 S Ste 106, West Valley City, UT 84119-6274 | 2018-04-30 |
| 1760979397 | Moenkopi Counseling PC | Clinic/Center | 230 N 1680 E Ste H2, Saint George, UT 84790-2585 | 2018-04-19 |
| 1669978896 | Southern Utah Vision Care Pllc | Clinic/Center | 1251 Northfield Rd Ste 215, Cedar City, UT 84721-8623 | 2018-04-05 |
| 1558876961 | Corner Canyon Recovery, LLC | Clinic/Center | 1450 E Pioneer Rd, Draper, UT 84020 | 2017-12-07 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.