Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Life Integrative Health Center

Organization Clinic/Center · NPI 1063833721

Life Integrative Health Center is a Clinic/Center in Provo, Utah. Licensed in Utah. Registered with an NPI since 2013.

Licensed in
UT
In the registry since
2013
Specialties on file
6
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Practice location Address checks out

777 N 500 W Ste 104
Provo, UT 84601-1541
Phone: (801) 869-8199
Fax: (801) 705-0436
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinic/Center (primary) Taxonomy 261Q00000X
Health Service Clinic/Center Taxonomy 261QH0100X · Licence NOT REQUIRED (UT)
Health Service Clinic/Center Taxonomy 261QH0100X · Licence 0000000 (UT)
Adult Mental Health Clinic/Center Taxonomy 261QM0850X · Licence NOT REQUIRED (UT)
Adult Mental Health Clinic/Center Taxonomy 261QM0850X · Licence 00000000000 (UT)
Adolescent and Children Mental Health Clinic/Center Taxonomy 261QM0855X · Licence NOT REQUIRED (UT)

Record details

NPI number1063833721
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Kendra Bernal — Clinical Administrator · (801) 869-8199
Other names Theta Wellness Center - Provo
NPI enumeratedDecember 26, 2013
Last updated in NPPESApril 9, 2014
Mailing address777 N 500 W Ste 104, Provo, UT 84601-1541

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