NPIMap

Organization Active NPI

Life Enhancement Center

  • Adult Mental Health Clinic/Center
  • Provo, UT
National Provider Identifier
1326304023
Registry record updated Jun 25, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X
License
5828209-6009 Issued in NU
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
Apr 6, 2012
Last updated
Jun 25, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2012

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

Authorized official

Name
Mrs. Shelley Mangum, ACMHC
Title
Ass. Clinical Mental Health Counsel
Phone
(801) 796-0620

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X 5828209-6009 NU Primary
Adolescent and Children Mental Health Clinic/Center 261QM0855X 5828209-6009 UT

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, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1333670400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1340582400000",
    "number": "1326304023",
    "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": "2012-04-06",
        "last_updated": "2012-06-25",
        "status": "A",
        "authorized_official_last_name": "MANGUM",
        "authorized_official_first_name": "SHELLEY",
        "authorized_official_title_or_position": "ASS. CLINICAL MENTAL HEALTH COUNSEL",
        "authorized_official_telephone_number": "801-796-0620",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "ACMHC"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "NU",
            "license": "5828209-6009",
            "primary": true
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "UT",
            "license": "5828209-6009",
            "primary": false
        }
    ],
    "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, 2012; 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.