Provider Demographics
NPI:1043091697
Name:WELL LIFE COUNSELING
Entity type:Organization
Organization Name:WELL LIFE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HORNE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-864-6767
Mailing Address - Street 1:1500 E 3150 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-3462
Mailing Address - Country:US
Mailing Address - Phone:801-864-6767
Mailing Address - Fax:
Practice Address - Street 1:4578 S HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:MILLCREEK
Practice Address - State:UT
Practice Address - Zip Code:84117-4243
Practice Address - Country:US
Practice Address - Phone:801-864-6767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty