Theta Wellness Center - Provo

LBN: Life Integrative Health Center
Theta Wellness Center - Provo is an health care organization with primary practice located at 777 N 500 W Suite 104, Provo UT 84601-1541. The organization recently has 4 registered licenses in different health care specialties including Ambulatory Health Care Facilities / Clinic/Center, Ambulatory Health Care Facilities / Health Service, Ambulatory Health Care Facilities / Adult Mental Health, Ambulatory Health Care Facilities / Adolescent and Children Mental Health. Ambulatory Health Care Facilities / Clinic/Center is the primary health care specialty. Life Integrative Health Center can be contacted via phone (801) 869-8199, or through Bernal, Kendra via phone (801) 869-8199.

Contact Information

Primary practice address
777 N 500 W Suite 104 Provo UT 84601-1541
Phone: (801) 869-8199
Fax: (801) 705-0436
Website:
Map and Directions
Authorized official contact:
Name: Bernal, Kendra Master of Arts (MA)
Phone: (801) 869-8199

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Clinic/Center 261Q00000X
Ambulatory Health Care Facilities / Health Service 261QH0100X NOT REQUIRED Utah
Ambulatory Health Care Facilities / Health Service 261QH0100X 0000000 Utah
Ambulatory Health Care Facilities / Adult Mental Health 261QM0850X NOT REQUIRED Utah
Ambulatory Health Care Facilities / Adult Mental Health 261QM0850X 00000000000 Utah
Ambulatory Health Care Facilities / Adolescent and Children Mental Health 261QM0855X NOT REQUIRED Utah

Profile Details

NPI number 1063833721
LBN Legal business name Life Integrative Health Center
DBA Doing business as Theta Wellness Center - Provo
Authorized official Bernal, Kendra Master of Arts (MA)
Entity Organization
Organization subpart 1 No
Enumeration date Dec 26th, 2013
Last updated Apr 9th, 2014 - about 12 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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