Provider Demographics
NPI:1053808477
Name:MINDFUL LIFE RECOVERY
Entity type:Organization
Organization Name:MINDFUL LIFE RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAMRIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARVER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, CSAT
Authorized Official - Phone:801-710-0780
Mailing Address - Street 1:484 S SUNSET RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84054-0186
Mailing Address - Country:US
Mailing Address - Phone:801-710-0780
Mailing Address - Fax:
Practice Address - Street 1:484 S SUNSET RIDGE DR
Practice Address - Street 2:
Practice Address - City:NORTH SALT LAKE
Practice Address - State:UT
Practice Address - Zip Code:84054-0186
Practice Address - Country:US
Practice Address - Phone:801-710-0780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-20
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT60127203902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty