Provider Demographics
NPI:1295093656
Name:LIFE TRANSITION COUNSELING
Entity type:Organization
Organization Name:LIFE TRANSITION COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL THERIPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:JERILYN
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:801-608-9325
Mailing Address - Street 1:634 E CLEARWATER DR
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-4284
Mailing Address - Country:US
Mailing Address - Phone:801-608-9325
Mailing Address - Fax:
Practice Address - Street 1:2317 N HILL FIELD RD
Practice Address - Street 2:103
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-4781
Practice Address - Country:US
Practice Address - Phone:801-608-9325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT179401-3501305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization