NPIMap

Organization Active NPI

Life Stone Group, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Midvale, UT
National Provider Identifier
1871829283
Registry record updated Apr 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
LIFE STONE GROUP, LLC
Practice address
613 E Fort Union Blvd Ste 104
Midvale, UT 84047
Phone
(801) 984-1717
Fax
(801) 984-1720
NPI assigned
Oct 20, 2009
Last updated
Apr 16, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2019

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

Authorized official

Name
Mrs. Julie A. Pettit
Title
Owner/Partner
Phone
(801) 984-1717

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU Primary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X 15893 UT

Addresses

Primary practice location

613 E Fort Union Blvd Ste 104
Midvale, UT 84047

Mailing address

613 E Fort Union Blvd Ste 104
Midvale, UT 84047-5531
Phone (801) 984-1717

Other practice location 1

150 S 400 E
American Fork, UT 84003-2510
Phone (801) 980-7222

National Provider Directory

National Provider Directory

Locations

150 S 400 E
American Fork, UT 84003
Phone (801) 980-7222

613 E Fort Union Blvd
Ste 104
Midvale, UT 84047
Phone (801) 984-1717

8153 S 4800 W
West Jordan, UT 84088
Phone (801) 984-1717

Practitioners & affiliated clinicians

Practitioners 38

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.

View all 38

NPI Registry JSON

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

{
    "created_epoch": "1255996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1555372800000",
    "number": "1871829283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "613 E FORT UNION BLVD STE 104",
            "city": "MIDVALE",
            "state": "UT",
            "postal_code": "840475531",
            "telephone_number": "801-984-1717",
            "fax_number": "801-984-1720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "613 E FORT UNION BLVD STE 104",
            "city": "MIDVALE",
            "state": "UT",
            "postal_code": "84047",
            "telephone_number": "801-984-1717",
            "fax_number": "801-984-1720"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "150 S 400 E",
            "address_purpose": "LOCATION",
            "city": "American Fork",
            "state": "UT",
            "postal_code": "840032510",
            "country_code": "US",
            "telephone_number": "801-980-7222",
            "fax_number": "801-980-7223",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LIFE STONE GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-20",
        "last_updated": "2019-04-16",
        "status": "A",
        "authorized_official_last_name": "PETTIT",
        "authorized_official_first_name": "JULIE",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "OWNER/PARTNER",
        "authorized_official_telephone_number": "801-984-1717",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "UT",
            "license": "15893",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Midvale, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2019; 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.