Provider Demographics
NPI:1639958812
Name:ABUNDANT LIFE INSTITUTE
Entity Type:Organization
Organization Name:ABUNDANT LIFE INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:XAVIER
Authorized Official - Last Name:AMPUERO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-427-0301
Mailing Address - Street 1:277 E 950 S
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84058-5004
Mailing Address - Country:US
Mailing Address - Phone:801-427-0301
Mailing Address - Fax:
Practice Address - Street 1:277 E 950 S
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-5004
Practice Address - Country:US
Practice Address - Phone:801-427-0301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-26
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty