Life Elevated Family Medicine & Counseling LLC

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

LIFE ELEVATED FAMILY MEDICINE & COUNSELING LLC

Practice address

3686 W. 2100 S.
Salt Lake City, UT 84120-8412

Phone

(435) 830-0554

Fax

(385) 247-8023

NPI assigned

Oct 1, 2021

Last updated

Oct 1, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Brock Dan Haskell

Title

PA/Owner

Phone

(435) 830-0554

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1633046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633046400000",
    "number": "1366114944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2561 S 1560 W STE B",
            "city": "WOODS CROSS",
            "state": "UT",
            "postal_code": "840872361",
            "telephone_number": "801-505-0821",
            "fax_number": "801-505-0803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3686 W. 2100 S.",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841208412",
            "telephone_number": "435-830-0554",
            "fax_number": "385-247-8023"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5667 S Redwood Rd Unit 6",
            "address_purpose": "LOCATION",
            "city": "Taylorsville",
            "state": "UT",
            "postal_code": "841235433",
            "country_code": "US",
            "telephone_number": "435-830-0554",
            "fax_number": "385-247-8023",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LIFE ELEVATED FAMILY MEDICINE & COUNSELING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-01",
        "last_updated": "2021-10-01",
        "certification_date": "2021-09-15",
        "status": "A",
        "authorized_official_last_name": "HASKELL",
        "authorized_official_first_name": "BROCK",
        "authorized_official_middle_name": "DAN",
        "authorized_official_title_or_position": "PA/OWNER",
        "authorized_official_telephone_number": "435-830-0554"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "118561179-1206",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Claire Lies
• Amber Marie Lietz
• Life Care at Home of Utah, Inc. (Affinity Hospice of Life)
• Life Care at Home of Utah, Inc.
• Life Changing Therapy
• Life Health Medical Center, Inc.
• Life Health Regeneration LLC
• Life Skills Vocational Center
• Lifepath Home Health Care, LLC
• Lifeskills Vocational Center

• Multi-Specialty Clinic/Center in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Multi-Specialty Clinic/Center in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2021; 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.