Provider Demographics
NPI:1821762923
Name:AFFIRMATIVE LIFE SKILLS
Entity Type:Organization
Organization Name:AFFIRMATIVE LIFE SKILLS
Other - Org Name:VAL HENRIE JOHNSON
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VAL
Authorized Official - Middle Name:HENRIE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:435-261-8160
Mailing Address - Street 1:1130 W GOLDENROD CIR
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-7512
Mailing Address - Country:US
Mailing Address - Phone:435-261-8160
Mailing Address - Fax:
Practice Address - Street 1:135 N 900 E STE 3
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3265
Practice Address - Country:US
Practice Address - Phone:435-261-8160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-03
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty