LIFE INTEGRATIVE HEALTH CENTER
NPI 1063833721
Clinic/Center in Provo, UT

Q: What is the provider's specialty?

The provider's specialty is Clinic/Center with taxonomy code 261Q00000X.

Active since December 26, 2013

777 N 500 W, SUITE 104, PROVO, UT 84601(801) 869-8199(801) 705-0436 Get Directions Write a Review

NPPES record last updated: April 9, 2014. Verified against the NPPES registry weekly; last sync: July 19, 2026.

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About Life Integrative Health Center NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LIFE INTEGRATIVE HEALTH CENTER (NPI 1063833721), doing business as Theta Wellness Center - Provo, is a healthcare organization registered as a clinic/center in Provo, Utah and active in the NPI registry since December 2013. The organization lists Kendra Bernal, Clinical Administrator, as its authorized official.

NPPES Registry Identity

NPI1063833721

Entity TypeOrganization

Primary Taxonomy261Q00000X

Legal Business NameLIFE INTEGRATIVE HEALTH CENTER

Location Address777 N 500 W, SUITE 104Provo, UT 84601-1541

Mailing Address777 N 500 W Ste 104Provo, UT 84601-1541 · (801) 869-8199 · Fax (801) 705-0436

Phone(801) 869-8199

Fax(801) 705-0436

Organization SubpartNo

Authorized OfficialKendra BernalClinical Administrator · (801) 869-8199

Enumeration DateDecember 26, 2013

Last NPPES UpdateApril 9, 2014

✔ NPI 1063833721 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

★ Primary SpecialtyClinic/CenterAmbulatory Health Care Facilities

Taxonomy Code261Q00000X

Definition

A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

Also ListedClinic/Center · Health ServiceTaxonomy 261QH0100X · License 0000000 (UT), NOT REQUIRED (UT)

Also ListedClinic/Center · Adult Mental HealthTaxonomy 261QM0850X · License 00000000000 (UT), NOT REQUIRED (UT)

Also ListedClinic/Center · Adolescent and Children Mental HealthTaxonomy 261QM0855X · License NOT REQUIRED (UT)

777 N 500 W, Provo, UT 84601

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