Provider Demographics
NPI:1316493521
Name:SERENITY RECOVERY AND WELLNESS
Entity type:Organization
Organization Name:SERENITY RECOVERY AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LYNDSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:PROCTOR
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-618-7331
Mailing Address - Street 1:12447 S CROSSING DR
Mailing Address - Street 2:13
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84096
Mailing Address - Country:US
Mailing Address - Phone:801-984-0184
Mailing Address - Fax:801-984-0186
Practice Address - Street 1:12447 S CROSSING DR STE 13
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84096-7020
Practice Address - Country:US
Practice Address - Phone:801-984-0184
Practice Address - Fax:801-984-0186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-28
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8699899-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty