Provider Demographics
NPI:1386983740
Name:AUTISM JOURNEYS TREATMENT CENTER
Entity type:Organization
Organization Name:AUTISM JOURNEYS TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:KATE
Authorized Official - Middle Name:DAHLE
Authorized Official - Last Name:ANDERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-718-6441
Mailing Address - Street 1:PO BOX 119
Mailing Address - Street 2:AUTISM JOURNEYS
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-0119
Mailing Address - Country:US
Mailing Address - Phone:801-938-9268
Mailing Address - Fax:801-572-7460
Practice Address - Street 1:675 E 500 S
Practice Address - Street 2:SUITE 360
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-2818
Practice Address - Country:US
Practice Address - Phone:801-938-9268
Practice Address - Fax:801-572-7460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-05
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5193889-2501251S00000X
UT5095471-6004251S00000X
UT320820-4102251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health