Provider Demographics
NPI:1073268231
Name:INNER PEACE WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:INNER PEACE WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:STEED
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-372-4466
Mailing Address - Street 1:11075 S STATE ST STE 16
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-5196
Mailing Address - Country:US
Mailing Address - Phone:801-372-4466
Mailing Address - Fax:801-747-6879
Practice Address - Street 1:11075 S STATE ST STE 16
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-5196
Practice Address - Country:US
Practice Address - Phone:801-372-4466
Practice Address - Fax:801-747-6879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)