| Life Elevated Family Medicine & Counseling Llc | |
|
3686 W. 2100 S. Salt Lake City UT 84120-8412 | |
| (435) 830-0554 | |
| (385) 247-8023 |
| Full Name | Life Elevated Family Medicine & Counseling Llc |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 3686 W. 2100 S., Salt Lake City, Utah |
| Authorized Official Name and Position | Brock Dan Haskell (PA/OWNER) |
| Authorized Official Contact | 4358300554 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Elevated Family Medicine & Counseling Llc 2561 S 1560 W Ste B Woods Cross UT 84087-2361 Ph: (801) 505-0821 | Life Elevated Family Medicine & Counseling Llc 3686 W. 2100 S. Salt Lake City UT 84120-8412 Ph: (435) 830-0554 |
| NPI Number | 1366114944 |
|---|---|
| Provider Enumeration Date | 10/01/2021 |
| Last Update Date | 10/01/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366114944 | NPI | - | NPPES |
| 118561179-1206 | Other | UT | LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
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