Provider Demographics
NPI:1538659313
Name:PURE LIFE COUNSELING, LLC
Entity Type:Organization
Organization Name:PURE LIFE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:385-393-0055
Mailing Address - Street 1:189 S STATE ST STE 245
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84015-1001
Mailing Address - Country:US
Mailing Address - Phone:385-393-0055
Mailing Address - Fax:801-926-0704
Practice Address - Street 1:189 S STATE ST STE 245
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:UT
Practice Address - Zip Code:84015-1001
Practice Address - Country:US
Practice Address - Phone:385-393-0055
Practice Address - Fax:801-926-0704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-16
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty