Provider Demographics
NPI:1770787012
Name:UTAH'S CHILDREN'S JUSTICE CENTER PROGRAM
Entity type:Organization
Organization Name:UTAH'S CHILDREN'S JUSTICE CENTER PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CJC DEVELOPMENT & TRAINING COODINAT
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEKLEMIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-281-1238
Mailing Address - Street 1:5272 COLLEGE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84123-2772
Mailing Address - Country:US
Mailing Address - Phone:801-281-1238
Mailing Address - Fax:801-281-1235
Practice Address - Street 1:125 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025-2359
Practice Address - Country:US
Practice Address - Phone:801-451-3560
Practice Address - Fax:801-451-3555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2090084405174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty