1396549929 NPI number — LIFE ELEVATED THERAPY & COACHING, PLLC

Table of content: (NPI 1396549929)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396549929 NPI number — LIFE ELEVATED THERAPY & COACHING, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIFE ELEVATED THERAPY & COACHING, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396549929
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/02/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
125 W MAIN ST UNIT 466
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDWAY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84049-8020
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-842-1492
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1057 OBERLAND DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDWAY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84049-6112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-842-1492
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/02/2025

Additional Information

Authorized Official

Authorized Official Last Name:
WASHINGTON
Authorized Official First Name:
TRACY
Authorized Official Middle Name:
Authorized Official Title or Position:
THERAPIST/OWNER
Authorized Official Telephone Number:
801-842-1492

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com