Provider Demographics
NPI:1104673110
Name:CONSCIOUS LIVING COUNSELING CENTER
Entity type:Organization
Organization Name:CONSCIOUS LIVING COUNSELING CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:BAIRD
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC
Authorized Official - Phone:385-279-5350
Mailing Address - Street 1:1420 WESTBURY WAY APT J
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-4763
Mailing Address - Country:US
Mailing Address - Phone:385-208-2746
Mailing Address - Fax:
Practice Address - Street 1:1420 WESTBURY WAY APT J
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-4763
Practice Address - Country:US
Practice Address - Phone:385-208-2746
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-06
Last Update Date:2024-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty