Provider Demographics
NPI:1104078229
Name:ST. JOHN THERAPEUTIC SERVICES INC.
Entity type:Organization
Organization Name:ST. JOHN THERAPEUTIC SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:J
Authorized Official - Last Name:MERCIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-621-5385
Mailing Address - Street 1:555 E 5300 S
Mailing Address - Street 2:SUITE 6
Mailing Address - City:SOUTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84405-4509
Mailing Address - Country:US
Mailing Address - Phone:801-621-5385
Mailing Address - Fax:
Practice Address - Street 1:555 E 5300 S
Practice Address - Street 2:SUITE 6
Practice Address - City:SOUTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-4509
Practice Address - Country:US
Practice Address - Phone:801-621-5385
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT264211-3501101YM0800X
UT1437121357101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty