LIFE INTEGRATIVE HEALTH CENTER

PROVO, UT
NPI1063833721
Former Legal Business NameTHETA WELLNESS CENTER - PROVO
Entity TypeOrganization
Authorized ContactKENDRA BERNAL
Clinical Administrator
801-869-8199
Organization Subpart ?No
Primary Taxonomy261Q00000X Clinic/Center
Additional Taxonomies261QH0100X Clinic/Center Health Service
(Licence: UT  NOT REQUIRED)
261QH0100X Clinic/Center Health Service
(Licence: UT  0000000)
261QM0850X Clinic/Center Adult Mental Health
(Licence: UT  NOT REQUIRED)
261QM0850X Clinic/Center Adult Mental Health
(Licence: UT  00000000000)
261QM0855X Clinic/Center Adolescent and Children Mental Health
(Licence: UT  NOT REQUIRED)
Enumeration Date2013-12-26
Last Update Date2014-04-09
Business Address
LIFE INTEGRATIVE HEALTH CENTER
777 N 500 W SUITE 104
PROVO, UT 84601-1541
Phone number: 801-869-8199
Mailing Address
LIFE INTEGRATIVE HEALTH CENTER
777 N 500 W STE 104
PROVO, UT 84601-1541
Phone number: 801-869-8199