Provider Demographics
NPI:1104392802
Name:PROJECT CONNECTION UTAH
Entity Type:Organization
Organization Name:PROJECT CONNECTION UTAH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LENNIE
Authorized Official - Middle Name:NICHOLS
Authorized Official - Last Name:KNOWLTON
Authorized Official - Suffix:
Authorized Official - Credentials:CMHC
Authorized Official - Phone:801-633-6933
Mailing Address - Street 1:2670 S 2000 E STE 209
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84109-1783
Mailing Address - Country:US
Mailing Address - Phone:801-633-6933
Mailing Address - Fax:
Practice Address - Street 1:2670 S 2000 E STE 209
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84109-1783
Practice Address - Country:US
Practice Address - Phone:801-633-6933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-19
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty