NPIMap

Organization Active NPI

Life Enhancement Center

  • Community/Behavioral Health Agency
  • Provo, UT
National Provider Identifier
1083876734
Registry record updated Jun 25, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
6332186-0142 Issued in UT
Legal business name
LIFE ENHANCEMENT CENTER
Practice address
1835 N 1120 W
Provo, UT 84604-1180
Phone
(801) 623-4770
Fax
(801) 623-4771
NPI assigned
Jun 25, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Russell C Gaede, PSYDNPI 1225197759
Title
Executive Director
Phone
(801) 623-4770

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 6332186-0142 UT Primary

Addresses

Primary practice location

1835 N 1120 W
Provo, UT 84604-1180

Mailing address

1835 N 1120 W
Provo, UT 84604-1180
Phone (801) 623-4770

National Provider Directory

National Provider Directory
Tax ID family
Life Enhancement Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1835 N 1120 W
Provo, UT 84604
Phone (801) 477-0532

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1214352000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214352000000",
    "number": "1083876734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1835 N 1120 W",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846041180",
            "telephone_number": "801-623-4770",
            "fax_number": "801-623-4771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1835 N 1120 W",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846041180",
            "telephone_number": "801-623-4770",
            "fax_number": "801-623-4771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE ENHANCEMENT CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-25",
        "last_updated": "2008-06-25",
        "status": "A",
        "authorized_official_last_name": "GAEDE",
        "authorized_official_first_name": "RUSSELL",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "801-623-4770",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "UT",
            "license": "6332186-0142",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Provo, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.