Provider Demographics
NPI:1477985513
Name:SAINT ANTHONY HOUSE TREATMENT PROGRAMS
Entity Type:Organization
Organization Name:SAINT ANTHONY HOUSE TREATMENT PROGRAMS
Other - Org Name:THE UTAH HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALYCIA
Authorized Official - Middle Name:ERIKA
Authorized Official - Last Name:JURGELA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:801-678-3317
Mailing Address - Street 1:1370 S WEST TEMPLE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84115-5218
Mailing Address - Country:US
Mailing Address - Phone:801-678-3317
Mailing Address - Fax:
Practice Address - Street 1:1713 QUARRY LN
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75072-5080
Practice Address - Country:US
Practice Address - Phone:801-678-3317
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-31
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 251C00000X
UT85193680160251S00000X
UTLIC201300573251S00000X
UT20772251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled Services