Provider Demographics
NPI:1164857892
Name:JOURNEY COUNSELING CENTER SANPETE LLC
Entity Type:Organization
Organization Name:JOURNEY COUNSELING CENTER SANPETE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QUALITY ASSURANCE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-420-0465
Mailing Address - Street 1:41 WEST 700 S
Mailing Address - Street 2:
Mailing Address - City:EPHRAIM
Mailing Address - State:UT
Mailing Address - Zip Code:84627
Mailing Address - Country:US
Mailing Address - Phone:435-283-4690
Mailing Address - Fax:435-283-4389
Practice Address - Street 1:41 W 700 S
Practice Address - Street 2:
Practice Address - City:EPHRAIM
Practice Address - State:UT
Practice Address - Zip Code:84627-1524
Practice Address - Country:US
Practice Address - Phone:435-283-4690
Practice Address - Fax:435-283-4389
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE JOURNEY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-09-12
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1834253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency