Provider Demographics
NPI:1023627148
Name:CHRISTIAN CENTER OF PARK CITY
Entity type:Organization
Organization Name:CHRISTIAN CENTER OF PARK CITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF COUNSELING
Authorized Official - Prefix:
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:M
Authorized Official - Last Name:HARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-649-2260
Mailing Address - Street 1:PO BOX 683480
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84068-3480
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1283 DEER VALLEY DR
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84060-5182
Practice Address - Country:US
Practice Address - Phone:435-649-2260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-24
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty