Provider Demographics
NPI:1407377757
Name:LIFE LAUNCH CENTERS, LLC
Entity Type:Organization
Organization Name:LIFE LAUNCH CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JONI
Authorized Official - Middle Name:
Authorized Official - Last Name:DYCHES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-803-8240
Mailing Address - Street 1:315 W HILTON DR STE 3
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-2203
Mailing Address - Country:US
Mailing Address - Phone:801-803-8240
Mailing Address - Fax:
Practice Address - Street 1:315 W HILTON DR STE 3
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-2203
Practice Address - Country:US
Practice Address - Phone:801-803-8240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT101YM0800X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty