Provider Demographics
NPI:1336705292
Name:LIFE LAUNCH CENTERS OF SOUTH SALT LAKE
Entity Type:Organization
Organization Name:LIFE LAUNCH CENTERS OF SOUTH SALT LAKE
Other - Org Name:LIFE LAUNCH CENTERS OF SOUTH SALT LAKE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CFO
Authorized Official - Prefix:
Authorized Official - First Name:JONI
Authorized Official - Middle Name:L
Authorized Official - Last Name:DYCHES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-803-8240
Mailing Address - Street 1:230 N 1680 E STE J1
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-2588
Mailing Address - Country:US
Mailing Address - Phone:435-767-0552
Mailing Address - Fax:435-767-0278
Practice Address - Street 1:9289 S REDWOOD RD STE D&E
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-6730
Practice Address - Country:US
Practice Address - Phone:833-803-3883
Practice Address - Fax:435-767-0278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-16
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty