Provider Demographics
NPI:1255827416
Name:SERENITY RECOVERY AND WELLNESS OF PAYSON, LLC
Entity Type:Organization
Organization Name:SERENITY RECOVERY AND WELLNESS OF PAYSON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LYNDSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:PROCTOR
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-618-7331
Mailing Address - Street 1:1868 N 1120 W
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-1179
Mailing Address - Country:US
Mailing Address - Phone:801-984-0184
Mailing Address - Fax:801-984-0186
Practice Address - Street 1:1868 N 1120 W
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-1179
Practice Address - Country:US
Practice Address - Phone:801-984-0184
Practice Address - Fax:801-984-0186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-10
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty