Provider Demographics
NPI:1215374798
Name:SALT LAKE COUNTY CRIMINAL JUSTICE SERVICES
Entity Type:Organization
Organization Name:SALT LAKE COUNTY CRIMINAL JUSTICE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIVISION DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:K
Authorized Official - Last Name:DALTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:385-468-3425
Mailing Address - Street 1:145 E 1300 S
Mailing Address - Street 2:SUITE #501
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84115-5482
Mailing Address - Country:US
Mailing Address - Phone:385-468-3559
Mailing Address - Fax:385-468-3560
Practice Address - Street 1:145 E 1300 S
Practice Address - Street 2:SUITE #501
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115-5482
Practice Address - Country:US
Practice Address - Phone:385-468-3559
Practice Address - Fax:385-468-3560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-24
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT207091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty