Provider Demographics
NPI:1912092586
Name:UTAH COUNTY COUNCIL ON DRUG ABUSE REHABILITATION
Entity Type:Organization
Organization Name:UTAH COUNTY COUNCIL ON DRUG ABUSE REHABILITATION
Other - Org Name:THE GATHERING PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:E
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-226-2255
Mailing Address - Street 1:251 EAST 1200 SOUTH
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84058
Mailing Address - Country:US
Mailing Address - Phone:801-226-2266
Mailing Address - Fax:801-226-2578
Practice Address - Street 1:251 EAST 1200 SOUTH
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058
Practice Address - Country:US
Practice Address - Phone:801-226-2266
Practice Address - Fax:801-226-2578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11904251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare