1396573440 NPI number — ZEST FOR LIFE COUNSELING - ST GEORGE

Table of content: (NPI 1396573440)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396573440 NPI number — ZEST FOR LIFE COUNSELING - ST GEORGE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ZEST FOR LIFE COUNSELING - ST GEORGE
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:
1396573440
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/22/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
556 E 300 S STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AMERICAN FORK
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84003-3844
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-980-2566
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
491 E RIVERSIDE DR STE 3A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST GEORGE
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84790-7056
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-980-2566
Provider Business Practice Location Address Fax Number:
801-610-2017
Provider Enumeration Date:
07/22/2024

Additional Information

Authorized Official

Authorized Official Last Name:
HYDO
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
JOSEPH
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
801-433-8149

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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