Provider Demographics
NPI:1235663345
Name:SEVENTH STREET TREATMENT CENTER
Entity Type:Organization
Organization Name:SEVENTH STREET TREATMENT CENTER
Other - Org Name:7TH STREET
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC
Authorized Official - Phone:385-261-2068
Mailing Address - Street 1:2487 S 700 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-1722
Mailing Address - Country:US
Mailing Address - Phone:385-261-2069
Mailing Address - Fax:
Practice Address - Street 1:2487 S 700 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-1722
Practice Address - Country:US
Practice Address - Phone:385-261-2069
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-14
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT38350324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility