Provider Demographics
NPI:1104270768
Name:ATLAS THERAPEUTIC SERVICES LLC
Entity type:Organization
Organization Name:ATLAS THERAPEUTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCO
Authorized Official - Middle Name:
Authorized Official - Last Name:JURACAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, CMHC
Authorized Official - Phone:801-310-3091
Mailing Address - Street 1:451 E 1000 S
Mailing Address - Street 2:STE D
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-3700
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:451 E 1000 S
Practice Address - Street 2:STE D
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-3700
Practice Address - Country:US
Practice Address - Phone:801-310-3091
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-20
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8937085-6009251S00000X
UT8155586-6004251S00000X
UT2391843-6004251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health