Provider Demographics
NPI:1043688872
Name:CIRCLE OF LIFE COUNSELING CENTER
Entity Type:Organization
Organization Name:CIRCLE OF LIFE COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RICCARDELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-331-6775
Mailing Address - Street 1:3375 W MAYFLOWER WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-3134
Mailing Address - Country:US
Mailing Address - Phone:801-331-6775
Mailing Address - Fax:
Practice Address - Street 1:3375 W MAYFLOWER WAY
Practice Address - Street 2:SUITE A
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-3134
Practice Address - Country:US
Practice Address - Phone:801-331-6775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-10
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT369760-6004261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health