Life Tree PLLC
Nurse Practitioner, Psych/Mental Health in Salem, UT. Organization (NPI-2).
NPI number1982135265
StatusActive
Last updated in NPPESSep 1, 2026
Details
- NPI
- 1982135265
- Entity type
- Organization (NPI-2)
- Legal business name
- Life Tree PLLC
- Organization subpart
- No
- Enumeration date
- Mar 27, 2017
- Certification date
- Sep 1, 2026
- Last updated
- Sep 1, 2026
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LP0808X | Nurse Practitioner, Psych/Mental Health | – | – | Yes |
| 261QM0801X | Clinic/Center, Mental Health (Including Community Mental Health Center) | – | – | |
| 261QM1300X | Clinic/Center, Multi-Specialty | – | – | |
| 261QP2300X | Clinic/Center, Primary Care | 6227164-4405 | UT | |
| 363LA2200X | Nurse Practitioner, Adult Health | – | – | |
| 363LF0000X | Nurse Practitioner, Family | – | – | |
| 363LG0600X | Nurse Practitioner, Gerontology | – | – |
Other names
- Life Tree Psychiatry (Doing Business As)
Practice location
45 W 100 SSalem, UT 84653-9459
Phone 801-504-6665 · Fax 801-504-6073
Mailing address
45 W 100 SSalem, UT 84653-9459
Phone 801-504-6665 · Fax 801-504-6073
Authorized official
Josh Hooton
Owner/Provider
8055046665
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